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^FOR OFFICE tJSE .� ----------- Permit No. � � -P- ; 3D APPLICATION'S FOR SANITATION PERMIT r (,_4------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From.Date Issued I Healfh,,District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANALOCATION-. ---- ------ . -----------_-------------- Owner's Name____ -----:-. __ - ----------------------------------------- ---- Phone------------------------------------ �- Address---.-•-:----•• - Contractor's Name------ • --- `� ��•---•------•-----I •------------ Phone -•--_-------------•------- Installation will serve: Residence 9��partmenf Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other t Number of living units: __-f-- Number.of bedrooms - Number of baths --_ Lot size - �� mun system _i Depth toiWater Table 40-- ft. Water Supply: Public system [�Community system ❑'•Private ❑ 1 17 Character of soil to a dJ6Ph of"3"fie-+._ `San ❑"` d• Gravel ❑ SandQ 'Clay'y Loam 'Clay Loam ❑ Clay El Adobe [ ldardpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes El No �NA/VA: Yes [ No El OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available within 200 fe it.) a Septic Tank: Distance from nearest well-------_---------Distance from foundation___._r_------------Material__-____-____----__._____-________.. No. of compartments______. __ I T _ Liquidldepth_.._ ___-- Capacity 1 � Siz - ` p�, ...- , P 4' .... t � _ .Width of en Brest Ipt line--- ---------- Disposal _. s '� a ! om ill y 9 Err I Isn th- eh • W Dis osal Fiel Diumbere ofol nesearestwell. Distance of re each line ation _ - T #a rice A n �� 1 Type of filter-material_, --- epth of filter materia l_._-r-------- ---------- - 9 ,E Seepage Pit: Distance to nearest well__..___°-.__--._._ _Distance fro foundation-__Z,�-"---.Dista ce to nearest lot lin--- Number . g. 4 _ .. D al th - ----- r 1 -- Linin maternal:__": ��iSize: D:iameter__ Number of pits__..,_l__ p �-�----+�--- ' g r t �I i Cesspool: Distance from nearest well_________________Distance from foundatson...-- ________.-__.Linin mater t ,gal;. Depth----------------------- ------------Liquid a acitY Size: Diameter--------------------------- --------❑ �, Privy: Distance from nearest well------------------------- - - -----------------Distance from nearest building---------- ------ -- ------------------------ 0 4. ❑ Distance to nearest lots line...t_-_--_--- I ------------- - --------� I------------------- ----------- - --------- - -- - - r' P_ I Remodeling and/or repairing (describe):____-- -y4 1 t W_.�. --------------------------------------- ------------•--------------- ---------- ------------------------------------'-----------------=•----- _------ ----- -- ------ ---------------------------------- -- -------- ----•- - _ ----------------------------�-------I-------------------- ---------------------------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesfulations of the San'JoaquirVLocal Health District: and reg ( Y:--------------------- -- - --- --- -- ------------ - -- ---------------------- ` ------{a�fi Contractor} -------------- (Signed)--- - -- -t _- ----`�--------(Title)-- -- -- (Plot plan, showing size of lot, locarion of system in r ion to wells, buildings, etc., can bt3 placed on reverse side). FOR D.EPARTMENT�USE-ONLY APPLICATION ACCEPTED BY- - r ------- -- ------ -------- DATE----- 1��------------------ REVIEWE=D BY -------------------------------- DATE - DATE ---------- ------------------------- 1SSUED -: ' _BUILDING PERMIT Alteraton and/or recommenddtions _ = ----= ------- --- ---- ---- - ��j ••----- ----- �-`�-tib--/=L------ - --------- -----=--��_-_•::�_x�- ---- -- ---- -�'-r�"-c-�,` —� t� ------ --- ------------- + -� �- - --------- ----- --------------------------------------------- ----------------------------------------------------------------- _-. -- ---.C-�" Date --- - - -•--------' ---------------------------------- FINAL INSPECTION BY:_-:_ . _`�.. .-- . L.�_--- - --•--. SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West Oak Street 124 sycutnore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVIBEG B-59 3M 3•163 F.P.CC. ..µms