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I ---- APPL�\TION FOR SANITATION PERMIT Permit No. s��./-�- --- _ --- -- - - --- ... ....--- / - - - ------ --- ---- -... (Complete in Duplicate) Date Issued -:( _ _ _ _--.-._ This Permit Expires 7 Year From Date Issued .l pplication is hereby made to.the San Joaquin Local Health District for a permit to construct and�iyns"�tall the work herein escrbed. This application is made in compliancewith County /Ordinance No. 549. �. .5•yde- Jt�l9� /�6 LJOB ADDRESS AND LOCATION__!V�'L" -- J--��I •1` � --------- 4��Pz��1� � 1! ° ----------------. Phone Owner's Name..__.__"__ - ------ -- - - Address..----------- --- .' ---=---------------------------------------------------------------------------------------------------`-------------- - - - --------------------- Le ontractor's Name---- --'- -- -- -------------'-- - Phone---- Installation will serve: Residence ®/Apartment House ❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /... Number of bedrooms - Number of baths s/-_ Lot size .f�a��`� ,.��m-------------------- 6.Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table haft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan ❑ `Previous Application Made: (If yes,date_-'`-----._,.__._.I No New Construction: Yes [INo R�'FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS-. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from foundation_l`r�__-__Mat�naL��(,�.�-.�`--�----------- ` Septic Tank: . 'Distance from nearest well_ /a -� ,L_i.r/1 No_ of compartments--- -r-___----.--Size i ��.-_--'�--!``-�-Liquigd depth__�yf_r -.------Capaafyf- - --- �P - .e1-.&._.._..Distance to nearest loft line./ -----._ Disposal Field: Distance from nearest well- -Q _ .Distance from foundation- f lf� Number of lines__ f ___ ___.__ engfih of each line �O __.Width of trench� .� ------------- L A Total length ----------------- - -- ` Type of filter material!/ I� Depth of filter ma#enal_.,�,� -- 9 - �, Dis a to nearest lot line.t�0f L Seepage_Pit: Distance to nearest --- well ��--Distance fro foun ation. 9 q Numberofpits....-/r.---------Lmigg..material.___ fll Size: Diameter.3. .- _Dept 612 Cesspool: Distance from nearest well---_----------Distance from foundation---------------- Lining material-___-__..------------._-_--. 0 L Liquid Capacity gals. 11 Size: Diameter------------------------ ---------Depth--''- -'-----------------...------- - 9 P tY----------"----- ._-_..Distance from nearest building_..-._.__-_.-_______.._._._._. Privy: Distance from nearest well____...___.-._--_------_--_.---- _ �. ❑ Distance to nearest lot line._ ------ ------------------------- - - ! i Remodeling and/or repairing (describe):- . . ...- -- - --- ------ ----------------- -------- --- ------------------------------------------------------------------------------------------------ -----------'- ------ --- - -- ---u----------------ndt-h----------------- -------- ----- -----------------------Joaqu----- n---- I hereby certify that 1 hive prepared ts aQplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. - -_--- - - -- lQwweralyd r Contractor] 0 (Signed) � By:—------------------------ -- - ------------------- L - --- - (Plot plan. showing sae of lot, location of system in-relafio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p /� /j ----------------- -- DATE.-------��6-�---------------------- APPLICATION ACCEPTED BY_._.. L '....-��—.._---------------------- REVIEWEDBy----------------------------------------------------------------------------------- - — DATE.-------- ---------------------------------------- BUILDING PERMIT ISSUED______________________.____._.-- --- --------------------- -- DATE ------------------------------------------------ Alterations and/or recommendaf ions:--- ---------------------'"- ----------------------------------------------------— ------— ----------------- Alterations --- - - ----------------- ---- ------------------------------ ------------------------------- - -------------------- -- -------- ---------- --- ------------------------ _ _ FINAL INS- EC °f�/•.NN/�v�/ Date SAN JOAQUIN LOCAL HEALTH DISTRICT ` 300 West Oak Street 144 Sycamore Street - 205 West 9th Street 1601 E.Harell m Ave. - Lodi,California Manteca,Californ! Torry,Califomia Stockton,CaNfOasks :- - `