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FOR OFFICE USE:--------------------------- �- ' ----- ---------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .C1 �-<z ----------------- - --------- ------------------ --- (Complete in Duplicate) Date Issued --------------------------------_---------..---..--._._-_ This Permit Expires 1 Year From Date Issued i Application is hereby made to the',San Joaquin Local Healfh"Disfrict for a permit to construct and install the work herein described. This a plication is made in compliance,w'ifh'Couri,ty Ordinance-,N8?-549. Zai[ _ f�s-r�• 27 Wj_ 10— L, JOB ADDRESS AND LOCATION.- } Owners Name �---- -�- --'.--�_-:--:--_:-_=_-_- --_ - �""* Phone� �^��4f i Address -- ------------------------------ ---------------------------------------- -------------------------. -- Contractor's`Name_--__'- _:' " Installation will,serve: Resid'enee. M'Apar4ment House > Commercial r❑y Trailer Court ❑ ofiel ❑ Other 7 ~S`k4 t�yy F�� r Hupp yf li'vin nits:?+Q-r Number of bedrooms -------E,Number of baths _, __ Lot size ----------------------------------- Water Supply:,'Public.,s stem CSmmunity system ❑ Private [p`�Depth to Water Table-30 ft. Character ofsotl to ?;eap't., 'of 3 feet:' Sand ❑ Gravel ❑ SandyLoam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ a�.� � '4\Previous,Apphcatlon (If yes,date------�-------------) No New Construction: Yes, No ❑ FHA/VA: Yes ❑ No W TYPE,OF INSTAL•LAT'ION AND SPECIFICATIONS: { I #.(No septic;+antorrspool- ceapermitted cif,pu6lic sewer.is available within 200 feet.) t S it Tank: A- 1:1i from ten_are t w�e�ILCG�. �' Dlstancg/froin four dation__/�:_--.--_---.Mate rtal- ?'�Z_ _ ±"----------------------- -------- -------- - -------- [APit:,. No.`of,compartments!___ �� >------Size ---_ _�- -. -Li Liquid de th - ..-- Capacity !------- age q P. ---- p ty------ 101, I MspIstance fromFnearest well / ,V•+-__Distance from foundation- -_E4-:___---_-_Distance to nearest lot line_7777 - T umber of 'linesk-- - — ___.-__Len th of each line-_--*W111- Width of trench___ I lof �� g r �� - ,ype of filer materiaDepth of filter material----Ise____...__Total length- ` -------------------14 SeeDunce to'n'earest,well-4_._____-___-__,___Distance from,foundation-_--____r_-__----,Distance to nearest lot line--------------umber of pits._ --------Lining material----_--- Size: Diameter - .------. ---Depth_ _CesDitance from nearestel -----------------Distance from foundation---.- -- -.-..---.fining material-------------------------------------- [] 1 Slz'e: Diamt,ter..Y --- ----------------------Depth------------ -- ---------------------------------Liquid Capacity--- ---------------------ft.--g a;s, Privy: Distance from nearestf4well- -------------------------- -.- ---- - Distance from nearest bulldmg-_--------------_-----_-----__- ❑._ Distance to nearest lo'tfiline ---------------------------- f---------------------------------------------------- A#? ------------ -- ----------------- -- Remgde .nd r r airjnA( c r' � � ~ e -- . ................................... I'--------------- . fi i---------------------------------------------------------- ; i I he4eby certify. I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws„and rules and regulations of the San Joaquin Local Health District. i V �,'. - ' - - -------- ------`�----- ---- (Signed)1�-' --------' --�--�------------=- - �`�----�- ------ �cJ � --- ----------------- ----.-.-----(Owner and/or Contractor) BAY, ---.--------------------------------- - ------------------------ -----•--------------•-------- t- --(Title)- f , :1� (Plot pia', showing slze)of lot, locatton,af sysfem_in,relation-to wells,, buildings, _etc_, can 6e,placed on reverse side').- FOR ide). j ( FOR DEPARTMENT MSE ONLY APPLICATION ACCEPTED BY ------------r----------------- DATE--- ------------------ REVIEWED BY - f "�, DATE ='----•------------------------------ I I ---- .i - - 1 y, :. Alte Da+on and/ ITrecED DATE ------- -- I I omm dation - -- - Ute.~' - - ----• I/ t -- ---------- ----- ------------- ---- r 4- ✓�� Date--- FINAL INSPECTION � I SAN JOAQUIN LOCAL HEALTH DISTRICT � 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Mantecar California Tracy,California