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Id SANITATION PERMIT Permit :No APPLICATION FOR _ `T v (Complete in Duplicate) Date Issued iA plica§ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her n described. ; T Kis application is made in compliance with County Ordinance No. 549. `RISrew JOBAADDRESS•AND' LOCAT O ___.._._--- ne + -------------- Phot Owners Name"_ - .Y.. ... _ , Address--- - -- - - ------- - --------------------------------- i ------- ------ Phone--., ---�----- Contractor's Name---------------- - -�.:. .-- ---p- ---_- --------------------------------------------- �.. Installation will serve: Residence Apartment House ❑'° Commercial ❑_ Trailer Court ❑ /Motel ❑ /Other ❑ Number of living units: _ ""_ Number of bedrooms- Number of baths Lot size ---Cy-- - -/- - ----•-------------- Water Supply: Public.system Community system El Private E] Depth to Water Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobf Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No, t 1 , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest#well-----------------Distance from foundation_ Materia --------------------------------------- No. of compartments ' Size --------Liquid depth--------------------------Capacity----------------------- D � " Disposal 1=ie♦i� Distance from nearest well-----------------Distance from foundation______.____.____...Distance to nearest lot line-----*'"'-_`� `^ Number of lines Length of each line-----------------------------Width of trench-- -----------1--------------- �/ Type of filter material-------------------------Depth of filter material-----------=--.----r--Total length--------------------- -------- 1 '' _ f _, :^ Di an e to nearest lot line.e?�___-_ "" Seepage,Pit: "'Distance to nearest.well __'r---- Distance fro Tou atian__ ._ v Size: iometer----- --- - - Q► Number�of�pits.__��='.�""- ---Lining materia _ _ �� Depth------ Cesspool: Distance from nearest well_______._ -."_Distance from foundation-____._-_ "___..Lining material_"_.____.-----"-_.______"-___--__._-_ ❑ Size: ,D4i&ndte�•------" -{ -Depth------------------------------ --------Liquid Capacity gals. Distance from nearest buildin Priv Distancerfrom rearest well _=.__..__.____. -s- Distance to nearest lot Ione_________ _______.__ __.___.______._._ - - -- x i S; ! ,Remodeling and/or rEl ------------------------------------------------------------- Epairing (describe}_____________ ___ +. ! _ , -----—�-•-- -------------"---- - ------- -----------•-"---••----• { =A f ` -"�, I hereby certify that I.have re ared this a lication and that the work will be done in accordance with San Joaquin County y P P PP 4 f j '`��•ordinances, State laws, rule nd reg a ns of the San Joaquin Local Health District. ) _ 4 f -•--------- {O w n r r _ a tract r)_(Signed)- (Titl ------ ' B 6 ...m--' ;r 1 Y= Y e (Plot plan, showing size of lot, location of system in,relation to wells, buildings, etc., can be cod on reverse side] �. -I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- '---- -- � .r �-------------------•---------- DATE DATE---------- -------------------------------------------"--- ---------------"------------------------ ------------------------------------------------- ,. REVIEWED BY____ �, DATE------------ -�-----------=: ------------------------------- ------ BUILDING PERMI;(_ISSUED--------------- = t --------•---------------------•---------------- r " d_s._- ?� _ �'1_� '-��'- ---•----•------------ --------- Alterations and/or recommendations-------------- - t� --------------------------------- A - -------- =--. .�.--• ----- ------------------ ------- ----' BY:..-- - �------ - = = --------------------------------- FINAL INSPECTIONV � Date----_-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street_ 132 Sycamore Street 814 North "C" Street 130 South American Street_ Trae California Stockton, California Lodi, California Manteca, California y. E5--9-2M I IRevised W-2100 _