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FO OFFICE USE: o J - ' x Permit No. .. ••• ' - - -- '---�- �-�".--- -----"- "" --- APPLICATION FOR SANITATION PERMIT �i (Complete In Duplicate) 11 pate Issued -- ----- ---- x.:. -�- - "- "--�-"�--"" �--- This Permit Ex fires 1 Year From Date issued ------- - ------- ---------------- Y ' s•. ermlt to construct and install the work herein describe Application is hereby made to the San Joaquin Local HealirDisfrict for a p 'l 4 I Thls application is, made in compliance with County Ordinance No. 549. �4 _:.-1 -- ------------------------------------------ . OeA07 ;&� JOB ADDRESS AND L CATION.. -_�---- -- -- I, --- ' Pone ---- •----- �i ; Owners Name------ I -----•--------------•-- ----- --• --- ----------•--•-- ------------------------------------------------------- Address---------••-..------•--'•--- .�v- --•- •• - _ --------------•- Phone „ ----- -------- Other ❑ Contractor's Name_§__.- -•- Commercial ❑ Trailer Court [I Motel Installation will serve: Residence [¢Apartment House ❑ O / I Number of living units-.---/-- Number of be __2`- Number of baths o size - I � De th to Water Table ��~- It- Water Supply: Public system Eg"tommuriity system ❑ Private [IP ardpan ❑ l Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe[R�H Character of soil to a depth of 3 feet: Sand ❑ Gravel New Construction Yes o ❑--FHA/VA: Yes � -No)< t Previous Application ade: (if yes,date--------------- 1 No ! �� M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within:200 feet.) f 1 ---_"-__Distance from foundation__. i --------.Material__ r`L Septic Tank: Distance from nearest well_-____.__--- -�-.r •-• .> -�- - __ 19 , _, - Li uid de / Capacity- Septic No. of co partments"--- Size_ ��l i' q p f l!d' 'A ��.____""Distance to nearest lot line__---------• pisZOposal Fie4d: Distance from nearest ------ well --_-Distance ofreach I�e-om atio ------ Width of trench.�-.�--,--------------~--•- �/ Number,of lines_______---- -V-- -- -Length th of filter material- -Total length___.9------------------------------ Depth --- " Type of filter material/ " = p -� .i Size: Diameter__J��--------Depth- ` r_/r - _Distance to nearest o fine__"____.."____-._ Seepage Pit: Distance to nearest well______ _____- Distance from fou dation___s_l__-•_--- Number of pits---. ---- Lining material___ I ' Distance from nearest well----------------- from foundation----------------___Lining material__.__"__.___--------------------'-•-' � ---- __Liquid .Ca acit gals. l Cesspoo$: De th--------------- S',; ----- ------------------ Capacity ' ' ❑ e: Diameter--------- ------------------------ P � ,.Distance from.nearest well--------------------- ----- ------ ----- "----I°Distance from nearest building_------------------- ------------"-- Privy❑1 ----------------•------ -----_-------------------- i Distance to nearest.lot fine"----------------- - l a - --------- ------- ---- ---------- Remodeling - Eli ---------'-- Remodeling and/or repairing (descn e :____________ __ "----__- f f _______________________________________________________________________________ _____________"___________.___"______"_______ --------------------------------------------- I _______ _ _ _____________-____y--.__.____ __ .______.__________________"_ I hereby certif -the# I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local'Healfh District. gr Contractor] 1 Liocation �'�i ned g ] ' - (Tile]_By:-------------------•------------- ----------- - ' -(Plot plan, showing size o{ lotof system ' relation to wells, buildings, etc., can be lace on reverse side). USE ONLY FOR DEPARTMENT I , �;� �--y=---- ------- DATE- -l---- - I. APPLICATION ACCEPTED BY---- "-- -- - - - __ DATE------------------------------------------------------------ --- REVIEWED BY i DATE c---------- BUILDING. PERMIT ISSUED----- - - ==" r `� " --------- ------- Alterations and/ recommendations: 7" ----- ' I � ---- .{ ` FINAL INS CT10N BY----r-._,------ ,i, CAL HEALT ISTRI / 5�4N.`� Y beet 205 We 9th Street ��11 �A1esS Ql4Tree�..c ! '4„ —`;l Yc, :` �� 1401 E.41ellon Ave 4 acY,California ' 1 Lodi,California f� Mant'eca,'C ifor`nia .� �- l_ Stockton,California ES 9 RLVISE13 B-59 3M 3-'S3 F•.P.Co.