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FOR OFFICE-USE: / G Permit No. .%------------- PERMIT —-3---- APPLICATION FOR SANITATION PERMIT -- --- ---- ------------- (Complete in Duplicate) Date issued ------- ---- �, 'This Permit Ex fres 1 Year From Date issue -- ------ t� -------------------- made to the San Joaquin Local Health District 49 a permit n tdlne 'nstaIZ wor stein describe . Application is hereby ith Count Ordinance No. 5 ¢ This application is ma a in comp Iia Y CATIO Phone ------ JOB ADDRESS N --. Owner's Name------- -- -- --------------------------------------------- •------•--------------------•-------••-•---------- .. 6- L. -- -•----------- -•-- -. -• ----- -- Phor Address. -------------- ---• Contractor's Name. Other Comrriercta tai er ol 1. 'Motel ❑ artment ouse �- i Installation will serve: Residence Ap .. .__��----------- _ / Number of baths� .�-ot siz -' I Number of living units:/ ----- Number of bedrooms .-_ - I ft ❑ Community system rivate ❑ Depth to Water Table Hardparti Water Supply: Public system ❑ Ca Water Loam ® lay ❑ Adobe Gravel ❑ ,Sandy Loam�y Character of soil to a de +h.of 3 feet: Sand ❑ o ❑ Yes o ❑ - ...� p New Construction: Yes - ....I N o v Y ,,. .. r ' (if yes e- -- # Previous Application Mader - - =JTYPE OF INSTALLATION ANBDPdEGIFIA °I®NS' public ewer is available within 200 feet. (No septic tank or cesspool permitted if ubM }dial"------ -------- ------ -- ----- ----------- 11' .-, � - Dista`nc.5 f o,foun at n �r Capacity Septic Ta k: Distance from' nearest well ..............Size�i�----- liquid depth.---- de No. of 'compartmen#s '� Ditance to nearest lot line ----• om foundation -.-- r is osal Field-. Distance from e t well _---- -Distanceefr. g _ � } D' p :R Len t.:1 0,�e ch�linel- W1dth of trench.. Numbe of line.,,.,..-- - �..--;o Total. length....../9 -th9of�filtetrnaterial �_� :-- Type of ,Iter $a#eria_ _ p , x Distance to nearest well -"._.. Is- ------Distance from foundation"________________"_Dance to Depth lot line-"-__ -- -- - Seepage Pit: Dista Size: Diameter.-. ...I---------- p ❑ Number of pits----------------------Lining material.------------ - . Lining Cesspool: Distance from nearest well--------- ..Distance from foundation------ �iquida Capacity----- ----------------- -gals. Size: Diameter. .:. ---- - - - - ........... ----------------------- D.is . rmne t kuilding-------------------------------------------- Privy: - - ---- - - ------- --- Privy: Distance from nearest well. ... -. --------------------------- ---- --- ---- ❑ Distance. to nearest lot ins--------------------------------- ----- ------------------ -- -- -- --- - - -- Remodeling and/or repairing (describe): --- -- -- -- ---- "----------------------------------------- ---• ---•----------•--- - - -- ----- - --- -- - -------- ----- ---- --- - --- } -Euin Local Health Dis#ric't• Joaquin County -- :---------------- --- ----------------------- ihereby certify that: I have preps fed this applica+ion and That�}he,work-will=be done m accordance with an { ordinances, 5ta+e-laws, and rules and regulations of the San Joaquin ' ---------- -w—Pig -----. or Contractor)_. Si ned� ,,,ter,,,-( -5 ) - - _- - -(Tile)- ------ - n be placed on reverse side). (Plot plan, shawin4ize of lot, Iota+ion f system iq rrela}ion tow ._ din S. , . - : FOR DEPARTMENT USE ONLY T DATE----- . --- y- APPLICATION ACCEPTED BY --# A DATE REVIEWED BY--------------------------- ---------------------------------------- Bl11LDING PERMIT ISSUED „ +Ie !! ------=--------- -------- '��-- ----- -- Altera+ion'ns a'd%or rec mendations:--- ------- Y Ii4 ------------------ -------•------- ------------------- ------ --- ---------------- ------------------- -- - ------------------ ------------ -- Date------------- FINAL INSPECTIO - -- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazolton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,California Lodi,California r-.F.co.