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I--,' � ` APPLICATION FOR SANITATION PERMIT Permit No . (Complete Duplicate) Dote Issued -�~��6�� ~ / Application is hano6y made fo the Son Joaquin Local Health District for o permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 649. ' D,4,61 Owner's Name-------1-0�- -22cxr-�O-Aj-----------$-.01-j-----7��--- �- Z�.6---=--------- Phone------------------------------- Installation will serve: Residence F]" Apartment House [-] Commercial K Trailer Court [j Motel 0 Other E] Water Supply: Public system Community system jr F1 Frivate E] Depth to Water Table 14-- ft. Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adob Hardpan Character of soil to a depth of 3(eef: Previous Application Made: Yes Ej No)( New Construction: Yes E] No,�f FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance from 000rn,t vnU-----------------Distance from foundation--------------------Material --------.-------- No. of compor+ments-��-------Size.-_-.------_-Uqvid 6eRfh--------..'�upucity-------- ��.& � ` � Distance from nearest |L/�uw«m�, ��nn�e from foundation ^�� Di�once to nearest |of line-'s--- ------ Number of lines----------/---- ------------------Length of each line .-/0 . width of frun ---------------- Type -- Typu ofS|+er mnterio|-777�� Depth of filter material .-lk� ------Total |ong+h_- '_'-_---- Seepugu Pit: Distance to nearest wvU----.----Dis+ono, from foundation--------------------Distance to nearest lot line`---_' Numberofpits-` ,-''-�- --Lining �mu+e6uL'__'''��Size: Diameter-----------------------Depth --'-''-'-''''- CeopooL Distance from nearest well------------------Distance from foundation ------..---Lining material - --------------------------------- F1 --_-------[] 3ba' Diameter---------------- -------�_�. ----Depth '��'--'''''--_-''--''--.Liquid'Capacity---------------------------- Privy: Distance from nearest well--------------------------------- ---------------Disf ncu from nearest building------------------------------------------ El Distance to nearest ku |ioe'�� ---''--''''-'''--__________._________________�____________ � ' Remodeling orepairing�, ,�,o� mg (Jo`ori6o)��--I--.WJa.-Ta -1 '--1-]��>'-- ----------------------------------------- ' ------------------------------------------------------------^- ' _ -. ---------------------------------------------------------------------------------- '-_'-'--''------'-'--'-'-'------'-___-___--_._--_--_-_-_-._--_.--__-----.-._------ ~. prepared this lication and | hereby certify that | have � t� work will 6n done in accordance with San Joaquin Countyordinances, Stater laws, and rules and regulations the Sain Joaquin Local Health District. * ~ . (Signa6)--. _-�.� ~�~�� ----.-------k]wnorun6/o, Contractor) By-------------------------------------------------------- ~�_.�=,��'�_--_------�T��i-_.. ............. (Plo+ plan, showing size of lot, location of system in relation fowells, 6ui/6ingo, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY In -'----------' a ----------- Alterations and/or recommendations:---------------------------------------------- -------------------------------------------------------- -----------------------------------------------------.__.-------------_--..___.__---_.__--__.__-_- ---------------------------- ---------------------------------- __------` --------_----___��---------__-------____� ------_-------------____------'__-----____��--_��'___------'------_----__------'___��---------'---_ --._-_-_._-.__--_-._---_--'_-----.-_------_--_-_---_._-----------_. -'-----'---'---''-'''''_'''--.''-'�'��--'-''''-'''-'-'-_''''-�'''--''--'''''-'''-�'--'-'--, FINAL INSPECTION BY:-----------_..-��---__-___ Date--------- ^v---�_-��_�� SAN JOAQU|N LOCAL HEALTH DISTRICT 130 s""m American Street 300 West Oak Street /so Sycarno," s*em ow w"*h "C",tf reef Stockton, California Lodi. California wanm*°. oa|aorn* T="» Caln��"ia es-v-aw o°.i"°" 1.57 FYco.