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t-UK UrHU USE- --------------- --- SE-------------- , - ----------- --------- - N------- -------------- ---�- �.-__. APPLICATION,FOROSANITATION PERMIT Permit -- �-- ---. (Complete 1n Duplicate) --------------------- ------ -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the SanJoaquin cal He Ith District for a pe mit to nstru nd insta the k herein desered,- This application is made in compliance with Go y nalfic 9. IEE a 1 CCC JOB ADQRES AND LOC ON. - ----------------- Owner's Name---- ----- -- ---- -----------------. `, ,� -------- ------------------1------------ Phone--- ----- Address--------------- - Contractor's Name.. ---._. ----------------------------------------------- Phon Installation will serve: Residence -. ❑ Apa tmen# House Commercial ❑ vTrailer Court ❑ M A---- Number Other Number of living units: -------- Number of bedrooms ..._._.. Number -Lot size 9 __ y ❑ Communi#y system ❑ .Private Depth'.to W able Z-. ft. - _--� 7JJ Water Supply: Public system �•• Character of soil to a depth of 3 feet: F Sand G�av„el; y Glay'Loam-❑, .GI2y_[.Adobe ❑ Hardpan ❑ ❑ ��S�nd =foam- . Previous Application Made: [If yes,dotE___-... . _ ""'"�” No ❑ New Consf.:uction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or Cesspool,permitted if tc sewer is availabl wi�Nin,200 fe Septic Ta Not of from near,est�: 0 Distan e m f n. (------- al- ------------ " compartment Size =depth Ca acit ..- - Disposal Field: Distance from near. st well- -Q. -....Distance fromfoundat•oDistance to nearest lot line._ , =. ILJ� Numbed o$ lines-- `----- ---- ------- - - --Length of ac line "� D.mWidth,of;-trench. . r_ Type of;fil er mate .De th "`► / ' " p of it#er material__f-- t- Total' len th---/` I! --- g { Seepage Pit: Distance to nearest w ------- _-.. Distance from foundation.-...---;;.....Distance to nearest loft line.-.-_...#_---"__ 4 ❑ Number of pits----------------------Linin maferial Size:Dia`peter,^,...R.* .�---cp.epfh- Cesspool: Distance� from nearest well_--.__....._�Disfance -from fo%11undation.______.-"____--"_Lining material.._ ----- =" 5► ❑ Size ameter. ' '~;y--Depth---- --- ----- -- ------- ------ Liquid Capacity- --------------=--- --- Privy: Distance from nearest well.. .............. --.___-_-. �*' ++ Dista 57e from nearest ui inti -- ❑ Distance to nearest lot line—----:...:- --- ---------------------- ------._ ----------- ---------- Remodeling and/or rep ' ' {describe):__`-__- - - --------------------------------- r -.. - - `-- .'" herebycertify that I haveMpreperei�Xt"is applitatioa and that the wt wiliTbe done in accor4a cn a with San Joaquin County ordinances, State laws �f rules and regulations of fhe San Joaquin Local Health District. Cit ://Ilft�e ]I (Signed)---------- -- ✓ .- 54EI TIG4 TANK EFRVICB ----- ------- BY�295 :�4Riner Ave: a":o: (Title)------------- and/or Contractor] {Plot plan, showing size of lot, tyc`atton ofm in relation to wells, buildings, etc. I -- __ _ 4. € y �� ,tcan„beTplaced'on�Teverse side). FOVDEPARTMENT USE ONLY . . APPLICATION ACCEPTED By--- -- cC��Q,,,---• --- -- �""` +S'(o -- -------- --- -- "� = `DATE - �..---- REVIEWED BY -------------- %.. --- - ---- ---------- ------------ ----=----"-'-- -------------------------------------- DATE`-------------------•-- --------------------------------- ------ . -= :—. UILDlNG PERMIT ISSUED------------------------------- ------•------ - --- -R-'"-". 'DATE--------------------------------------------------------- --- Alteratii d/or recommendations:.. -'- l._ ----- •---------- --- - - .------ --------------- --------------- ----------- --------------------------- ----------- ------------------------- ----------- ----- --- 0 FINAL INSPECTION BY;----- ---- Date 1� ----------------------------- ------ A SAN JOAQUIN LOCAL HEALTH DISTRICT .. ` 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205-West 9 h Street � • Stockton,California Lodi,California Manteca,California Tracy,California