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71rUK vrrl(_t USE: --- f�------- �k9 •-_l _�_;. ._ APPLICATION FCR SANITATION, PERMIT Permit No. _ _/... _r.--•-_ -- ----- - ------- -------- i (Complete in Duplicate) ' This Permit Ex ires 1 Year From bate Issued I Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cons ct a in r^3o�o,00-2— r This application is made in compliance with County Ordinance No. 549. erein described. JO ADDRI SS A D LOCATION_.___ - Owner' me---------------C ` ,. -- r " --------- Qv Addre - __ Contractor's Named _ LJ✓ Phone. installation will serve: Residence Apartme ouse ❑ omme----- ��-� T/ ❑ Trailer Court ❑ o+el ❑ Other ❑ Number of living units: __.- Number of bedrooms ___ _._ Num;;��.DePf� - i !rte Lot size _ Water Supply: Public s stem -------------- Y y ❑ Community system ❑ � Private o Wafer Table _ t. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ "be and an li Previous Application Made: [If yes,date_...______,_______) No ❑ New Construction• � ❑ ► . Yes ❑ Na FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t o s ptic tank or cesspool permitted if public sewer is available within 200 feet.) S TaI Il Distance from nearest well-----------------Distance from foundation____ I No. of compartments' Size_ .__ -----material------------- D -------------Li Liquid de th.--------------- � • - - - q per. --•---- -Capacity------------ ----- -- ----------- � a� i `I ' �i ----------- Distance from nea est well__ Q.__ istance from foundat' --------Distance to nearest lot line s' _{ Number of lines__ rr r- --- -- ngth of each I'' _ ____-0__ .- Width of trench__ -Ij•C___--- � I Type of filer material__ -_ - _- pfih of filter m erial_. �� �� -------Total length------------- [� Seep gE�Pit: Distance to nearest well Q ------------ - istanom f undatian__ ___ - -`_,D' tan tp near lot line--- _ Number of pits..-----------------Lining aterial- -- Q-_"--- ---.Size: Diameter- -- ---.Depth---- _ �_--_------- �T Ces�ool: D2etance-f rom.nearest well-----------------Distance from 'undation.__.__.----------- y ----- Cesspool: L Hing material---------------------------------- �y Depth - ----------------------Liquid Capacity----------------------- Distance Privy: from nearest well __ _ ----------------------_----Distance from nearest building_,-_ ' ❑ Distance to nearest lot line"'___-_--- --- - -------- 6 k It --- ------------------==" r. Remodeling and/or repairing (describe):______ -"-- ----------- - -�1_ t� -------------------- ------------ ----- �` j " �: ---------------------------------- ------ F --------- ' -----------------� fi ------ ---- --- ------------------ ------------------------ ereby certify +hat ave prepared this application and that the work will be done in accordance with San Joaquin County ordinan4s, State laws. ales and lregulations of the San Jo in Local Health District. k (Signed)-----, a(Ja � r k EP7"fC"-TANK-"SeRW' E-------------------------------- - -------- ---------- By:----2915_E,_MinerAve_,.'--H0,q-.q 41 on+ract -- Her - - - ---- -------- (Plot plan, showing size of lot, locationtof system in relation to e f _ ui in s, etc., can placed on reverse sides. FOR DEP MENT USE O APPLICATION ACCEPTED BY__.--- _------- - ----- --------- 6/ ---="DATE--------- bs^ ----- ---------- --------- ------ DATE----- --- BUILDING PERMIT ISSUED ---------------------------------------------------------- i _.. . DATE � --------------------- Alterations - and/orrecommendations: !___r1 ------ L _ --_-- - ,- �_ = x–�c .�l --- -------- --------- -------------- ------------ -------- ------------ ------------------------- ------ --------------------- FINAL - FINAL INSPECTION BY: . __- - Date -------------- N AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California G Tracy,California r•.P.eo.