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.y FOI OFFICE USE: �.. f 1/ Permit No. � APPLlCATiON FOR SANITATION PERMIT --------------- - ------ (Complete in Duplicate) ------- - - - Date Issued -- ----•- - --- "--- --------- This Permit Expires i"Year From Date issued ---- ----------------------------- - - Application is hereby made to the San Joaquin Local) He-aat CDiNoic 549-a perrnit'to construct and install the work herein describe ' This application is made in compliance with County -------- --------------------- JOB ADDRESS AND,L ----41 04W __ I Phone- owner's honeowner's Name-------- �_ - Address------------------- •`- fJ Phone----------------------------------- - .. ----------------- Contractor's Name------------------------- Other Apartment Howe ❑ Commercial ❑ Trader Court ❑ Motel ❑ � Installation will serve: Residence Ap t 7, - ��-,---_..__-------------- Number of living units: -..I--- mber of bedrooms--ember of baths -------- Lot site ___�-- f�-t Private ❑ Depth to'Water Table -zW T Water Supply: Public system Community system [ _ �ardpan ❑ ! Gla Loam ❑ Adobe Character of soil to a depth of 3 feet: `Sand ❑ Gravel.❑,�,5andy Loam ❑ Y FNA/VA: Yes ❑ o Previous Application Made: (if yes,daee------------- -----f NO 13d 'dew Construction: Yes No ❑ # I TYPE OF INSTALLATION AND SPECIFICATIONS.:;,, — i (No septic tank or cesspool permitfedi.if puiiiic sewer is available within 200 feet.j �_� Mat�riaiE'G •��- - • �� Ca acit l "�' Septic Tank: Distance from neap st well ---- Distance from found atiLn uid depth_--1---�- p y_'___ Size_, q ----- No. of compartments------ � _ ii.'�' , }-3o" Width of trench ----- -j b 1 Disposal Field: Distance from nearest{well. _--&_6- Distance from foundation_.___ ------eDistance to nearest o+ line---- -- ---_---Len th of each lineJ_'---- �r Number of lines P "' * -Total len th-----��a�---- ID Type of filter ma�� a A from foundation g _ -------------------.Distance to nearest lot line----------------- D __._.--------- • N" e to nearest w.eil..._--.___- . _ IJ�s+`ance fr -I nc �� De th of:fi ter ma ena_ Seepage Pit: Dista e f `�"ma efi rial�*�-- Diameter-----------------------Depth--------------------------------- Number ------- ------- ------- ------ ❑ Number of pits------- : - "It$ Lining ------------- Size. Distance from nearest well.--- -._. Ott -Di stance 1from foundatio -------------------Lining material__._._------------------------------- Cesspool: _Li uid Capaci+y.------ gals. Size: Diameter------- ; _ Depth-- ............... ------ q ❑ Distance from near�st�wr,�e�ll_--- - - ----�`._-�-.++-.� �--- ----''Distan�e from nearest building......................................... 1 Privy '. .""s =: ❑ Distance to nearest aot line"----.------k-------------- iv--- °. - • -------------- ------------------------------------------------ --- ---- - Remodeling and/or repairing (describe);:!-_ ----------------- -------------- l 'k --------- .. ---- ------------•- qpL{ -µ---------- -------------------------------------------------------- -----1 r 7711 _ _ ----------------------------------------------- - -__ "------------------ r that the work will be done in accordance with San Joaq ----------------- - a,; _______________:__Fr = uin County � I hereby certify that I have prepared this application and ordinances, State laws, and rules and regulations�of�the San Joaquin Local Health+ District. ------------------------------------ ------------ (Signed) --------- --.(Owner and/or Contractor) Si ned----------------------------------------------- _ ( 9 )----- -------- ------- -------:---------_- ---:--- ------ - ---- -- - ------(Title)--------------------------------------------- ------ ----- --- ---- -- - - ----------------------------wells----- ------buildings, (Plot plan, showing size of lot, location of system in relation to , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I DATE-------; + ----46------------------------- APPLICATION ACCEPTED B ---------------------------- REVIEWED BY - ------- ---- --------------- -------------- DATE--- - ------- ------._ ---- DA BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ --------------•--------------------------------------- -------- Alterations and/or recommendations-------- ------ ------- --------- ------ ----- - -------------- 3 ------------ ----= s - ------------------ ------------------- --------------- -------- --------- FINAL INSPECTION BY:...... --- ------ ------------ Date --------------------------- ---- - --- --- ------- --------- - FINAL INSPECTION BY---------- ---r--- -- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street I 601 f Nazeitan Ave, 300 West Oak Street California Lodi,California Manteca,California Tracy, Stockton,California F.P.C O.