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FOR OFFICE,•USE: l -------------------=------------------ ------------ ---•--------------------- : APPLICATION FOR SANITATION PERMIT Permit No. _ . ------:------ -----------------------� --- (Complete in Duplicate) Date Issued This Permit Ex fires 1 Year From Date Issued Application is hereby made to the San "Joaquin Local Health District for a permit to construct and install the work herein d s ribed. This application is made in compliant with County 0?8inance .No. 549. Kf .JOB RDDRESS AND LOCfATkO �a 1��S Q ---------------------� =r' = 14.R.QF1 _'vF ..: ._�_y+ ame---- 1[l 1�'1 ._._ __. I7W�:`.I_N_--'S~-`--- Phare = Aoddress .T .._ ..t� GIANT-e }---a---------------------- Contractors Name_OW-NEh _-•--- ----------- =:--------------------- --------------- ------'Phone..... •--------- ••-------_ Installation will serve: Residence A p artment H'o.se�ElCommercial;"❑ Trailer Court ❑ Motel ❑ Other ❑ Number er'o of living units: y Numbf bedm roos Z Number of baths .__I--- Lot size ----A4R.E _ATT __K-------------------- (n.Supply: Public system ®,.,,Community system ❑ Frivatepth to Water Table 18_ ft. Character of soil to a depth;yof 3 feet: 'Sand k ' Gravel ❑ Sad'Loam ❑ Clay Loam ❑ Clay ❑ •Adobe ❑ Hardpan ElPrevious Application Made: '�(If yes,date------ -----------) No [ New Construction: Yes ElNo HA/VA: Yes ❑ No Eilf TYPE OF INSTALLATION AND SPECIFICATIONS: �s :r(No septic-tank or cesspool=permitted if-public-sewer is'available within 200 feet:) ^-~ Septic Tank: Distancelfrom nearest well---S ......Distance from 4oundation.-.L0----------Material---- No. of compartments.._--Z-- --------------Size-X ------Liquid .---.Capacity---, _ ----__ -.� Disposal Field: Distance from nearest well_5 -----Distance from fou{dation---/-__ ►s 5 II d I �.___ Distance to nearest lot line__._.__.._...... F-VSTI/46 Number of.dines=----- -------===== •----Length of each`line - -- 4 rr--- Width of trench".----- ----------------------- ------ Type of filter material-- -RQCK___.Depth of fi[ter`material-_.....1- _------. g .Total length -----------•- eSeepage Pit: Distance.to nearest well-------------- -- Distance from foundation _ *"'.Distance to searst lot line_____________ __ ❑ Number of its_P ____________ __ Lining material------- - _.Size Diameter-------- ---- --- -----Depth------ ----------------------- Cesspool: Drstance from nearest well------------- ---Distance from-.fouund tion---___--_._.__.---"Lining material---------------.........---.---------- El Size: Diameter----------------------:- _ -. ----..pe#th !'" �--------_--__ --.----Liquid Capacity gals. Priv Distance 4-'�-4l► 4 from nearest well ----------- ------ --,y----_--.._...Distance from nearest building 5 - ❑ Distance'tb'nearesflo+line- ------------------------------------------------ Remodeling and/or repairing [describe ------- / -------------------------------------------- -----------'-----:-."r ----------------- ----------------------------------- ---- ----------------- - +�' hereby certify that 1 k = --- ave prepared this application and that the work will be done in accordance;with San""Joaquin County ordinances, State laws, a ules and regulations f the S oaquin Local Health District. (Signed]---- --- ---- ------ ---------:----------- ��1� - (Owner and/or Contractor] ` (T • � - - lila) — - - (Plot plan, showing size of In"t, location of system in relation to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED,BY-- ....- e-- `Q'------------------------- ---------------------------------------- DATE--------- 4 . ---- REVIEWEDBY------------------------------- -- -------------------------------------------------------------- ----------- DATE------------------•--------------------------------------- BUILDINGPERMIT ISSUEDI`-----------------------------------------•--------------------•--------------------------------------- DATE------------------------------------------------------------- Alterations and/or,recommendations:----- - ----------- ,-_ -d_ ----.----------- - ----- ------ /----------------------------------° -----•-•---=------------------------ -- - y,E :. ..h w,.r k -SE.-7._ _._-_--------------------------------------------- -----------------------------------------------------------_.._s.._.____________ _._______...._____.__..__._--._.___.__.._._______________.._..._--. ---------------- ... — - i ---------•----•................ •-------i------- --- ------------------' --- ---- -- - --- ------------------------- --- -- --- ----- ------ FINAL INSPECTI .- =`L Date----------------� 1 .. -TX6- ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT le i 1601 E.Hazelton Ave. ' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California