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FOR OFFICE USE: __ - �---:_lC_____________._ _ .- _.-.-----. APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- (Complete in Duplicate) `._.__.._._ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordirl qnce No. 549. JOB ADDRESS A I (O "S�i . Owner's Name�--.f----/----------- --------- --- ---•--- --- --------------- ---- ------ - --------------------- � Phone—_ ----------------------- Address 7 ---------- --- --- - -------- - --- ----- -- - - -- - i. Contractor's Na a-- ----------- ---- -- ------ --- - •----- -------- o - - % Ph -- ---- Installation will serve: Residence rtment House ❑ -C mercial ❑ Trai r Court ❑� Motel'o Other ❑ Number of living units: _ -_--- Nu er of bedroo �^ . g � ms--�- Number of baths _ _ _ Lot size _7 __.__��- Water Supply: Public system Community system ❑ Private E] Depth to Water Table_ ft Y.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ - " j Previous Application Made: (If yes,date---_----------------) No ❑ New Construction: Yes ❑ No FF{A/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if ob�licsewis available within 200 feet.)Se tic ank: Distance from nearest well I ta e fro foun n __.___.-_. ater L.. No. of compartments_�_.r-c;1 ,S1iz��87-K6 iq,id ci,pth�t-...___Capacity__/ bispos Field: Distance from near st welLi. _1►14istance from foudation_I_Q Distance to nea est'I f'line_ �.._____ I t Number of lines--- ------ -- -------- --------Length ofFeach lime.- __ Q Width of #ranch._ ----- --.-- ---------- Type of filter material __ _ Depth o-of filter mate rial - ��1._._Total length---- _____ _ _______________ ' e r— Number of its- Linin material______._ founation'-.�_4 ._._.Disj�nce 'nearest lot line__ S p a Pi#: Distance to nea t ----- _ Distance om Size: Diameter- 4= Depth__ --_____--__.. Cesspool: Distance from nearest well_____------_____Distance from fbun ationf.:................Lining material------------- .-n..------------------ ❑ Size: Diameter--------� Depth`� :. � # } ------------------Liquid Capacity.--------------------------gals" . y❑ 'r - :rte '%'^i -------------------------------------------- ^} -, Priv Distance from nearest well------------------------------ _________D stance from nearest building I Distance to nearest}lo# line-------------------�------- .----------.--=------- Remodeling and/or s repairing (describe)--------- ---------- ------ ---- - --- --------- --------- -- --------------------------------------- --------------------------------------------- - ------- - ------ - -" -- h - - - ---- -------- ------------------I-------------------------------------------l---------------------------------- ----••----- ---- ! hereby certify that l have prepared this applicati and t at the work will be done in accordance with..San'Joaquin County ordinances, State laws, ane, rules and regulations of t e an . .o qui�n Lacal He Ith District. -- - ----` - ---------- ----- - ne or Contractor (Signed) �i� _----- - ---- ) SEPTIC TANK SI;R-------------- VECS� Oy' ^zJl f:Miner Qv HQ.6 384 ----- - ---(rifle)----------- € ....... I (Plot plan, showing size o ot, location o system in relat to we s, ildings, can be placed on reverse side). a i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ---------► --;�------- - �r 2-� "B - -� -- -•-----------�---------- DATE-�:`---------- --�--------� ----------------------- - I: REVIEWEDBY--------------------------- ---------- --------- --------- --- - ---------------------- --------------- DATE--------- ---------------------------- BUILDINGPERMIT ISSUED---------------------------------------- -------------------------------------- DATE------------------ ------------------------------------------ t Alterations and/or recommendations----------- ------- ----------------------------------------------------------------------------•---------------•-------------------------------------._ -------------------------- ------------------------- ---------------------------------------.------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: fY ------------ Date------ �6 (° 'l° --------------------- --------------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California e-a.co. s