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OFFICE USE: !J - Permit No.-51 L7FOR el- � APPLICATION FOR SANITATION PERMIT[Complete in Duplicate} Date Issued - �"------------- -,This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin ocall Hdenath DiNoc for o a permit to construct and install the work herein described. This application is made in compliance with County a7- - ---------------------- -------- JOB ADDRESS AA LOCATION / s y Phone /3 Owner's Name---- Address �-- Phone - `� lLr�- - - - - - •-��-------- Contractor's Name] ` Other ❑ Commercial Trailer Court ❑ Mot ❑ Installation will serve: Residence DI<Partment House 0'I Lot size ��/" �N r of livin units: _f-.- -- tuber of bedrooms- Number of baths Number g t. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table - Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy New Construction olny Loam 0 Yes ❑ Noa ly ❑ HA/VA: Yes ❑ No [IPrevious Application Made: {If yes,date------------------ -I No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material------------------------------------------------- Distance S ICAT Distance from nearest wel4_----"--_..-_-___ from foundation________________-_ Ca acit No. of compartments—----------------------Size----------- --------------------Liquid depth---------------- ------- 2-a�1__--_.Distance to nearest lot li��-- s�l edd: Distance from nearest well-r 4ge---Distance from foundation__- 01 ` ' Length of each line__-- -- ----------Width of trench. -------- Number of lines------ i g ........ otal length 0------------� /9- g l �9� Type of filter materia4_,�k�-�-��-Depth of filter mat riaL_-----L- _� Distance�t nearest loeil ___�.�-Q- �I -4, Size: Diameter__. PDepth___,. . Seepage Pit: Distance to nearest well_}ck(-e-------Distance m 4ondation___ Number of pits.__-�_-------------Lining mater;al__ - -1�-1! ---'_.-Linin material--------- --------------------------- Distance ----- ------- ---------- ool: Distance from nearest well_________________Distance from foundation_.----___.-- 9 Ce'ssp Liquid Capacity gals. Size: Diameter------- ---------- -------------- -Depth----------- ------- ------- --- --- ----- ----- - 9 p Y--- ------ ------- ------- �' ❑ Distance from nearest building ---------=----------- g --- - Privy: Distance from nearest well------------------------- ---------------------- - --------------------------- ❑ , Distance to nearest lot ine------------------- -- I ' --- ----- --- { --- Remodeling and/or repairing [describe):__-__-. _- _----__ - _ ------------------------- --------------- ------ --------- --------------------------------------------------------------- ----------------------------------------------------- ---------- --------- ------- ------ -- ------- --- ----------------I --------------------------------- -------------------------------------------------------------- ---•------------------------------------ ------ -------- ------- ------ hereby done certify that I have preparedis apions Ili that h work the San Joaquin HealtheDistr District. accordance withSan Joaquin County I ordinances, State laws, rules,and reg n.: --&P--al t- --------- -------------------------- - -- --- �r Contractor] I [ 9 } ----- - Title SF-PTI TANK ii�IG.lw - - ------ --- --- - [ } By:---24j.&E-.MkinerAve;; t#@ �_ �$' ------------------------------ [Plot plan, showing size of lot, location o system in relation wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �� - DATE----- =�p -� ------------------------------- APPLICATlON ACCEPTED BY- DATE---------------------------- - --------- REVIEWED BY----------------------------------------------------------------- ------ C ---- ------- - DATE---------------------------------------- ----------------- BUILDING PERMIT ISSUED-------------- -------��-f-_----------------------------------------------- - -----------•-------------- Alterations and/or recommendations:.___-_.-_-----.��' ---------rte--- 13--6 " -------------------- --------------------------- --------------------------- ------- "" ------ ----------------------- Date---4%_-�-- ------- - --- F1NAL INSPECTION BY_____________'_.. -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetton Ave. 300 West Oak Street 124 sycamore Street 205 west 91h street ' Lodi,California Manteca,California Tracy,California Stockton,California F.RCO.