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Permit No. 0 <br /> APPLICATION 0ORISANITATION PERMIT -------- <br /> ---------- 7.ovep�ll (Complete in Duplicate) Date Issued <br /> -------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ----------------------------------------------- <br /> Installation will serve: Residence-f parfment House C] Commercial E] Trailer Court E] Motel/11 Other El <br /> Water Supply: Public system P-l"Community system El Private Ej Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam L] Clay Loam E] Clay [] AclobeEl-lHardpan 0 <br /> Previous Application Made: Ufyes,date---------`--- -j NoE;,''New Construction. Yes E] pHA/VA. YooNo E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> � <br /> UWm septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 7 Se [�~~ nk: D�stonce �o U � _'�-&s� Material _l���r��- <br /> � � F�No. of compartments ±� ------------ <br /> Disposal <br /> � ^ ' <br /> Dis | o|6: Distance from nearest weK2?t7n--.(D-istunxe from foundation ..Distance to nearest lot one----------------- <br /> Number <br /> -- --..Num6vr of lines------ -- Length of each line--.fj� /�����77'vVid+h t h «�o <br /> -- Type of filter mo+e� L <br /> � - J)x! of filter material -x_��-------Total length------- --------------- «3 , <br /> Seepage Pit: Distance to nearest well -'_ ----------Distance from foundation-------_---------- Distance to nuenuline 00 I <br /> [] Number ofpits----------------------Lining material _------Size. Diameter_--------------- ----Depth---'------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------ --- ---------Lining material --'''_-''---- <br /> F1 Size: Diameter-----._--.-_Doofh-----------------------------------------------------�qui6 Copacit^-_-_-_'_.ga|,. <br /> P6.y: Dist noe fnzm neures well '''-''' ------------------------------Distance from nearest building----------------- ----------------_- , <br /> 0 Distance +nnearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------___----- ------------------- ----- ------------------------------------------------------------------ <br /> -------------------- ------'---'--'---------------'---'----------�-'-------------' <br /> '-'-'------''-''-'''-''-_--__'__-''-_-'-_-'__-''--'-'__-'__.''-_-'--'-'''_-.---'-''-''---_'-. <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have this | nd ththe work will be done in accordance with San Joaquin County <br /> ordinances, S�fafela and rules and regulations oft the San Joaquin Local Healfk District. <br /> By:----------------------------------------------------------------------------------------------------------------------------------- -le)------------ ------ --------- ------ <br /> (q� plan, showing size � k� location of system in relation to wells, buildings. etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> xEv/Ev,Eu u,._---_--------------'f----��-'--- ---'---' °"'�----------'--------- <br /> BU|LD|NG PERMIT ISSUED\ -- ,,--- DATE.'-''--''-' -' - -_ ' ` <br /> Alterations and/or recommendations:.........1_.L2�_/--- <br /> SANJOAQU|NUOCALH6ALTH DISTRICT <br /> vmw1m.Hazelton Ave. 300 West Oak S',"e' 12^Sycamore Street u0aWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E° 9 °=°"" "'5° 3" "'oo ,.~"". � - <br />