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f�/�/yam FOR OFFICE USE: � `� Permit No. c�..11-•�.._ APPLICATION FOR SANITATION PERMIT --------------------- -------"--------- (Complete in Duplicatel -Date Issued ---------- -- ------ This Permit Ex ires 1 Year From Dade Issued _.-_"_------------------------ ----- ------------ perm to construct and install the work herein described. r Applicationis hereby madeco the San e with Joaquin ccaOrdenatnce District 549 a p This application ---- ---- - ,70B ADDRESS AND LOC;}A�TIO9�"--.--- - - n _.""--------- -- ----------------------------- T 4V.__1__l.j"�-•--- ------------------------------------ Phone e ' ---------------------------- ----liija Name ---x ------------- - t bbl nd� - ----- ' Address----------------••-------�-�r�---�•-•---- - Phone---'-------•---•------•-•--•----•-- Contractors Name__-_.F............ ------- -- - ER------------------------------------ -----•-------• -- Mote; ❑ ter ❑ Apartment House ❑ Commercial ❑ Trailer Court Installation will serve: Residence [►�' p x_ t -' Number of living units: _.�.---- Number of bedrooms _ Number of baths -. Lot size -------- -------------------- Depth to Water Table -------- ff. Y .Y,� Adobe 2--Hardpan ❑ 7 Water Supply: Public system ❑ Corr+munit s sGravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet' Sand ❑ New Construction: Yes No E] FHA/VA: Yes [3NOD Previous Application Made: (if yes,date--------------------1= No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material."____ -- r 'S� Distance from nearest well---tr�0----'--Distance from foundation___:- ---- Capacity Septic Tank: -----------No. of compartments.-_ ------�.---- -----Size- ---------=- "--------Liquid depth---'---- '---- --------- '.No. -- -- :' Distance from #oundation____/ ----------Distance to nearest lot gine___nS_.._--•--. +/ Disposal Field: Distance from nearest well # ....fir . Number of lines-------------- -- -. --Length of each line_----------S�.FF-_-----.Width of trench P1--- i -- Total len th-----------16 L�----------------- i Type of filter material --�'--�Epth of filter material_._._-� Distance-to nearest well----------------------Distaai e from founds ze npiameter------------Distance to Depth lot line_---------:- Seepage Pit: Linin mater = 1 Number of pits --- ---- - - -- g Linin material- ---- --'----- ---------- { Distance from nearest well----------------- from foundation-------------------- gals. 1 i Cesspool: I ---------------Liquid Capacity....................... ❑ Size: Diameter------------ _-- ---' Depth ---- .Distance from nearest building.-----------•--------- ---------- -- i. Privy: Distance from nearest well----- ---------- -------- -----------------------_ --------'------------- I ❑ Distance to nearest lot line---------------;-.---' Remodeling and/or repairing (d©scribe):_ " ------------ ------------------------E---- ------ ----- ----------- ------------ - ---'--------------------------- -- ------------ ------------------------ ---------------------hat -- --- - I herebycertify that I have prepared this applyati San .laaquinhLocaI Health eDistrict.done accordance with San Joaquin County r ordinances, tate laws; and rules and regulations of (Owner and/or Contractor) w-)-- ----- ----- (Signed)-*------ s -- ---(Title)_ - (Plot plan, shhoo wing sizz e of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------------- ------ ------------------------------ DATE "7-: -- ---------------- APPLICATION ACCEPTED BY_ _ ------------------------------- REVIEWED BY------ ==-------------------------- ---------- -------------------------- ----- D -- } DATE 0 9i ., BUILDING PER ISSUED--------------'•----------------- _--�----------- -- - Alterations-and/or recommendations------------ r-----------ice - -ted 7------- ---------------------------------- ----------------------------------- --- --------- ----------- --- Jk ._-_ -------------_--------- ------------- -------------------- --- Date_( -�--- FINAL INSPECTION B �_ _ ------: SAN JOAQUIN LOCAL. HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 300 West Oak Street Tracy.California 1 601 E.Haxelton Ave. Lodi,California Manteca,California Stockton,California