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FOR OFFICE USE: ✓� st APPLICATION FibR J` --------- �_s ------------------ Permit No. �� .�-� SANITATION PERMIT (Complete in Duplicate) Date Issued -. ' ---------- - This Permit Expires 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 described. This application is made in compliance with County Ordinance No. 549. + JOB ADDRESS AND OC�ION........... -----�� `� - ----- 6 -- - Phone Owner's Name-- ------------ -------•--------•-•- ---- Address----•------------- -------------------- --- --------- ---- -s' Contractor's Name---- -------- - - -- p -- ---••---� ----�---------------------------- ------------------------------- -------•----- -. Phone----------------------------------- Installation will serve: Residence A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/- Number of bedrooms2_Number of baths -- Lot size ____;: � --y --------------- Water Supply: Public system ul-cmmunity system ❑ Private ❑ Depth to Water Table Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe pan ❑ Previous Application Made: (If yes,date_-_............. few-Constructions Yes-El No JV A: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' �Setic Tank: Distance from nearest well-----------------Distance from foundation-____---____p-.---.Material_...--------i-_.__-----__._-----__.._.--.---___.. No, of compartments------ ------Size------- ------------ quid de --------- - ----------gapacity-----------------r Disposal F' d: Distance from nearest well_-_._"�` --_Distance from foundation___/4�__.__.Distance.to nearest lot line_ ___..._-_. Number of lines_--------_-F----- - - -------------Length of each line__.._.- Width of trench-_ __ ��`e`� Type of filter material /�- __ :_D _ epth of filter material--------- length___.__ a------------------------ + _-_ _ C� �----- Jr Seepage Pit- Distance to nearest well______.__�---------Distance m foundation-___(.-______ _.Distance to nearestJ4t l� -_._ .. Size: Diameter - --��-----Depth.- 3------y °�Z �l�prnber of pits---�--�-{---=�; y-:Lining matenal----�� ------� �.. 4,. -- - - C sspool: i'•!L_ Distance from nearest well_ :__ _____-- Distance from f.oundat€on..__-::,�-'__._-.Lining materiaL________________-.__.__-- ___._.. ❑ -------Depth----------------------------- --------- -----Liquid Capacity---------------------- gals. N Size: Diameter-----�---- ----------- -� Privy: Distance from nearest well--_---------------------------------------------Distance from nearest building.____'------------------------_._....-_._. A— �. '==�-----`----- ❑ Distance to nearest lot line---------- --------- - --- ---------- --------------- - •---- ----------�- -------- 4 - .- - r. Remodeling and/or repairing (describe:---------______-----_`��c. -------• �Qq`{•.'�-- ------------------------------------------------------------------------------------------------ -------------------------------------------------- tA p --------- - -------- ------ ---- ------------------ ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St e a s, and rules and lations f the San Joaquin Local Health District.... tf --- --------- -- �------- - ---------------- - ---------- -------------- = ____-(Owner and/or Contractor) (Signed)------------------ --------------------- ITitl - # 8� Plot Ian, showing tz o loft, location of system in relatt FIs, buildings, etc., can be place an reverse side). ( P g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.- --- -------- DATE K 11 ------------------ REVIEWEDBY------------------------------- DATE-- =------------------------------- ------------------------ BUILDING PERMIT ISSUED--------------------------------- ••------ ---------------- DATE. terations nd .or recomme dations: ------ - -------------•-------- ------------------------------------------------------------------------------------ ----------------------- FINAL INSPECTION BY:-.-. - C-ff-`------------------------------------------- Date_.. �` y ' SAN JOAQUIN LOCAL HEALTH'DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street x5124 Sycamore Street 205 West 91h Street Stockton,CaliFornia Lodi,California Manteca,California Tracy, California F-P.CO.