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APP[ICATiON FOR SANITATION PERMIT Permit No.~- (Co7plete in Puplicate) Date Issue', Application is hereby made to the San Joaquin Local HeaihTS—ct�f—oplrrnif to construct and in f o he in described. � This application / do in compliance wifh County Ordance No 5+9 JOB ADDRESS AND LOCATION--/�79V-ko?w- --- Installation will serve: Residence [] Apartment House [] Commercial E] Trailer Court 0 Motel R��Other 0 Number of living units: -4/0--- Number of bedrooms -dl�- Number of baths 46�-- Lot size ----Z, ------------------- Wafer Supply: Public system F-1 Community system E] Private 28-*'6-epth to Water Table,7(!p--,ff. Character of soil to a depth of 3 feet. Sand F-1 Gravel E] Sandy Loam D41'15ay Loam 0 Clay E] Adobe Hardpan Previous Application k4a6w: Yo, E] No El New Construction: Yo, D No 0 FHA/VA. Yes El No E] TYPE OFINSTALLATION AND SPECIFICATIONS: (No septic tank nrcesspool pnnn|Hed if pu6kcsewer isavailable within 200 feet.) eptillank: Distance from nearest well-----------------Distance from foundaf;on------------------- of compartments--------------------------Size.......------- ------------ ---Liquid 6epfk--------.Capacity- ------.. d: Distance from nearest well - ----------- Distance from foundation_------ Distance to nearest lot line..-'_-- Num6o, of lines-----------------------------------Length of each line------------------------------ of tron6'-'''-''------ Tvoe of filter material-�� Depth of filter material -'-'''�_�To+ | leng th --------------------------------------- Distance _'-'''--_'-'--_ D + cv +o nvu , | � � . to � . � � -_---Num6er of pi+`---� ----Lining muferiu /0564 - Diameter-� Dupf6.. � - � Distance from nearest well-----------------Distance from foundation-------------------- mote6*L---------.-- - ��^ � Size: Diameter'__'---�--� ----Depfh----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------'Di�"noa from nearest 6ui|6ing_'__--._'---- F1 Distance to nearest lot line' . ' Remodeing on /pr repo|rinn /6ovch��'---''' .- -------------------------------------------------------- . n� ._-____.___._-._._----.-__.__-_-__..-_--.____---___—_--.-_-.�.-_---._--------- '--_--.-'-'--.--''-'-_'--_.''- _--'''_--'-_.'-_.--_..-_.'_-.-_.-__.--__.''-'''-_'_-.'--'-'_-'-_ ^ = ��' ------ ----- _ ------'- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances;Sfa;fell iws, and rules d regulations of the San Joaquin Local Health District. ------------- (Plot plan, showing size of location of system in relation to wells, buildings, efc., can be platce:ffonn revers FOR DEPARTMENT USE ONLY -------k-------------------------------------- --------------------V---------------------------------------------- Alterations and/or recommendations:---------------(-- ------------- --------------------------------------------------------- ____._—_------------------------------------------------------------------------------------------------------------------ —'-_'------_-'''--__-''--.'''��'—'-'---''--'''-__''-_''''-_-'---__'--_--'''-_-''___.._-'-'- _ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' --------------------------------__��_---------__-----___-------_----______-__----^___---___-------____---___----_____-----__--------------__---__---___---_-----_--' ^� - �^ � � FINAL INSPECTION -------------------- Dat�-'e�—.�'''_''--'''-��---''-'-'-'-- SAN JOAQU|N LOCAL HEALTH DISTRICT /m x*ufh American Street 300 West Oak Street /32 Sycamore Street ww North "C" street Stockton, Calnvrnla Lodi, California wam*** California rmv' California