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F R OFFICE USE: ______________________._.__--.---..-.._".-.- -__-_. APPLICATION 1=0R SANITATION PERMIT Permit No. _. ..... 5.... ._ ------- -------------------------- --- ------------ {Complete in Duplicate} Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San JoaquinLoa eal}h District for a permit to construct and install the work herein described. This application is made in compliance with G un dinance No. 549. IL r - JOB ADDRESS AN �OCATIIN----r--��--- -- ----- ------ ---- ----- -------- - -Owners Nameq - -- -• --•--- -- ---------- Address . `�2 � t om-- --', s -•-•-------------------------------------------------•------p------ Contractor s Nameii_ - ----- �• �** ---------------------------------------------- Phone.444 T'-- Installation will serve: Residence Apart nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ /---- Number afhs __I.._ Lot size __fP � . 7.-,0--'* 1_._._ Number of be _ _ _. ._... __ _ _____________ Water Supply: Public system ❑ Community system ❑ Private e Depthto afer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [I Clay ❑ be ❑ Hardpan F]Previous Application Made: (If yes,date--------- --------- ) No E] Now Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYP OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tic*T Distance from nearest well-----------------Distance from foundation--------------------Material------_------_--_-__-----_.----_-.__"__-.._-___-. No. of compartments----- --------- -------- Size-----•--------------_-----------Liquid depth1.11_ --- Capacity----------------------- 05 Distance from near st well,57-0 _Distance from foundati /� _.Distance to nearest lot lin -__1�f ____ Number of lines______ _ _ _ _______ Length of each line___. Q_�` �.01Width of trench__- ♦_' �_� ------ Type of filter materia. __. Depth of filter material-_-.....i-�--------Total length-------_---------_________ ! _____. Seepage Pit: Distance to nearest well_________________ Distance from foundation--------------------Distance to nearest lot line----------------- w ❑ Number of pits----------------- -_Lining material----- - ----------- Size: Diameter----------- -- --- ----Depth--------------------------------. Cesspool: Distance from nearest well _-------------Distance from foundation.___--------------- Lining material-----.--____"___-______.___-_-_-_--_. ❑ Size: Diameter----- -- --------- -- ---------------Depth--------------- ------------------------------------Liquid Capacit --- ------------------------gals. �d Privy: Distance from nearest well-____________ _______"..___-_____"-.__._._.._Distance from nearest buildin ----- ----------------------------------- ❑ Distance to nearest lot line------ ---- ------------------- -- ---- ------------------------------------------------ ------------------ --------------- ----------- N Remodelingand/c, repairing ( tribe)=-------- - ------------------ ---------------- - --------------- ---------- - ------ --------------•----------------------------------------- V1 ----------------•------- -------------------- - ---- -------------------- ----------------- ------------------ ------ ---------- ---- ----- ----- ol ---- - ----- --------- --- ------ e y ----eby ce • y t at I ared is cation n th A ill be d in actor ce w' n Joaquin County or inances, t la n rule and regiii tions o the n oaqu o a e Ith tr c (Signed) ,�.. , C or Contractor B -------------- • -- = : -- ---- ----{Title)---------- ---- - ---------------------------------------------------------------------- an, showing size of lot, location of system in relation to s, liifdings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY. -- -______ -' REVIEWEDBY------------------------- -------- --------- --------------------------------------------------------------------- -- ----- DATE------------------- ---------------- --- ---------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ---- ------------- DATE-------------------------------------- Alterationsand/or recommendations--- --- ---------- - ------------------------ -------------------------------------------------------------------------------------------------------------- ----- ----------------------------------------------•------------ -----------------------------------------------------------------------------------•------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------- ------ -------------- -- ----------------------------------------------------------------------------------------------------------------------- ------- ----------------- FINAL INSPECTION Date 6 &� --------- --- ------- .... ----------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,'California C.P-c o.