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7FR OFFICE USE: �/ •� : . I .-� APPLICATION 'F,OR SANITATION PERMIT Permit No. -_..___. ...-- -- ----------------------------------------------------- -------- (Complete in Duplicate) -._ - Date Issued �G1--- --- ------ �3 ' .__. , This Permit Expires 1 Year From Date Issued z A licaion is here pP thereby made:1�to the San Joaquin Local Health District for-a permit to construct and install the work hereincrib d. This application is made incompliance vAh County,Ordinance No. 549. o r . 106 ADDRESS AND CATION_________________-----_;__.. -. -- -� � 1 - -------/x__ ? __ ,----. - ----- Owners Name :: fa �°� !' - ------ Phone------------------------------------ Address------_-------- C` ---------- �l�-S- � � �� Phone-•----•---_--•--•-------------- Contractor's Name.:_ ti ------------ ----------------------- •- I lIIJJJ Installation will serve: Resi'�encs Apartment House ❑ Commercial ❑ Tr 'I Court ❑ Motel ❑ Other ❑ f t i-t -l- f . ` -1-, ------ Number of li�ing.units: -----;'Number of bedrooms _ Number of baths -_ ____ Lot size __ Water Supply: Publ c;syst!m ❑ Community system [j Private Depth to Water Table 0 ft. Character of soil to a di pth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ ' 4 i ' e____________________1 No E] —New Construction: Yes No E] FFiA/VA: Yes ❑ No ❑ Previous Application Mader (If yes,date---- TYPE OF INSTALLATION�AND SPECIFICATIONS: No septic tank or cess ool permitted if public sewer is available within 200 feet. / �` � r- ( l Septic Tank. Distancf��e(from nearest --'Distance from found _ation_ 6_f_--.----Maternal-, ..___. ___ .-.s.............../ No, of�compartmen s__-_` '.Size_ . - Liquid depth_L____________________Capacity___ _&` T__� ^.. --- f Disposal Field: Distance from nearest,well,ktl--------Distance from foundation_/0--_-----Distance to nearest lot line_______ Number of lines------ -___ Length of each line____________ __�-____.Width !of trench__.____ ------------- T of filter material__ ft- Depth of filter material---- -_ �---Total length____------------- pe Ty :._ / ce Seepage Pit:. Distance to nearest,well-- -�C�_____Distance�om f undation-._.�j_fe2l___.Dista t -- ___...o nearest lot line � �r Number of pits.__.__ --------Lining material�__lQ� �--.Size: Diameter._. __ .`.Depth____--- _�_______________ O Cesspool: Distanc-pe from nearest well------------------Distance from foundation----- ---_.Lining material______._.__-_.__-----_-_.-__-______._ ❑ Size: Diameter-------- ----------------------------Depth----------------------------------------------j----Liquid Capacity----------------------------gals. Privy: t Dist�i dg from nearest well---------------------------------- .•._Distance from nearest building=-----_-------•------:-------------- I ----------------------------- 1h ------------ ----- .� Distance to nearest lot line...__.___-._ _...- y Remodelingand/or re airm describe __________________________ ___ 4 , 1 f� / relairing ) - 1b — = - ------------- ---------------------------------------------- I --------------------------------------------------- ------------------- 1I1I- --------------•------------------------------------------• --------------- ytj ------------------- ` --------------- ---------.I -------•-----------'`-.w.�..m...r.__-- -R...- !---- --•------=- -------- "'--*--------------------------- - ----- I hereby-- tify that 1'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,/."tate laws, anc. rules a regulations of the San Joaquin Local Health District. (Signed) - ---------------- - -- ---------------------- wrier and/or Contractor) --, �(�� ._' ----'-�------- ---------------_-- ----_--- -- ------ By=---------------------------„.. - ' ' ✓ {Title) t (Plot plan, showing size of jot, location of system in relations! .wells, buildings, etc., can be placed on reverse side). 3 �Ip FOR DEPARTMENT USE ONLY ` i II 1----------------------------------------------- DATE----- J T` G }--------------- APPLICATION ACCEPTED BY_---._�`�___________ __ ____G�'" - -� REVIEWED BY = - ------- DATE BUILDINGPERMIT ISSUE'-.--- -A--------------------------------------------- ----------------- DATE-----------------------------------------11-------------------- Alterations and/or recommendations:__._----._ � � `__. - "- -"��- �' J---•-•-�/ e -�!`... ---------------- "r` >3-----------------------------------------------------•--------------------------------------------------------------- rIli ---------------------------------------------------------- 1 �r -----------------`------------------------------------------ -------------------- ----- -- FINAL INSPECTION BY:----- � C ~� O - ------ ---------- Date...-. / . --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californi I Lodi,California Manteca,California Tracy,California ES 9 REV16E0 8-54 3M 3-'6 I F.P.CC.