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FOR OFFICE USE: I� ��--------------- II APPLICATION FOR SANITATION PERMIT Permit No. •.................... {Complete in Duplicate} Date Issued -_ =_ --- ------------------------ 4 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for ermit to +stru-ct and install rein descried. This applica#ion is made in compliance with County Ordinance No. 549, R �� JOB ADDRESS ANDLOCATION �.. " !' ,0'1.- 1------'-------- ._ E• i 1F- ------ -- WT 'Owner's Name---� =S '! �CL�II ---- ------ Phone- Address- - P -'"1 ta Contractor's Name-- ---- SGP._.. l 1.� � -- --- ------------- Phone�F_._-- ---!�_-------•- Installation will serve: Residiilnce Apartment H quse ❑1 Commercial ❑ railer Court ❑ Motel ❑ Other ❑ living � 1 ---- _ 1 Number of baths -1----- Lot size �'� ----------------------------- Water Sum ter Public stes� Gommuniit sestem'E] Private De' th'to Water Table _______ ft. Supply: Y I ❑ � Y Y ❑ P '- Character of soil to a depth' f 3 feel Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: I (If yes,date---------------_---l No ❑! New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION ND SPECIFICATIONS: No septic tank or ce spool p4mitted if public sewer is availa6le within 200 feet.) Sis : Distancefrom nelrest well----------- --Distance from foundation--------------------Material-----.-----_____..._____.______._.______..___. No. of compartments------ -------------------Size--- ----•----------- Liquid cl�.th-------------------------.Capacity-------------4------ ! Dis o Field: Distancelfrom neares" —twell1_0_0_.....Distance from foundation-R5-----------Distance to nearest lot line___ Number;h f lines----1---------------------- Length of each inA',&-1e= ----------------------Width of tr nch------------ -- - ---------- � Type of�'iiter materia!------------------------Depth of filteral -------_.__-- ___---Tota! length__ _-------:-------------4------- � ,I 0I�f Seepage Pit: Distance)to nearest well-- ________.Distance from fo ndation_ DDistanse to nearest to line.....= Number: : f pits._.____________ -: __ ____Lining material_i .__.Size: Diameter __7L -----Depth..-- --------- Cesspool: Distance f,om nearest well_______________Distance f-romp oundatian____________________Lining material---__--__--________._..__________:__. ❑ Size: Di i meter Depth '-�----------------------------- ------- Liquid Capacity .gals. Privy: Distance from nearest we11___________________ --------______________________Distance from nearest building ---------------------------4_--.W__-.r Distance,to nearest lot line--------------------------------------------------- ------ Remodeling and/or repairing (describe)------------------------------------ ----------------------------------------------------------------------------------------------- ------------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- ------ -----------ill!------------------------------------- --------------------,------------------------------------------------------------------------------------------------- ;---------- V n- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---- . ----- I hereby certify that I have prepared this appiic�tion andthat the work will be done in accordance with San Joaquin County ordinances, State laws, and;! ees and regulations of the Saan,Joaq in Local Health District. a 2a Z? ni 4t {: -__ .1 --------._-_____ ----------- -Owner and/or Contractor (Signed)----------------------------- -----� - V.1 ---- ----- SEPTIC TANK SERVIC) BY:------ 91b-$:-Itl4i+�er-A+te:r ' .- 4.' -- --- (Title)' ------ ---------- ---- ---- (Plot plan, showing size of lot, location of system in relation to wepi'Wb ings, e# , can be pl d on reverse side). d! 'rFO'R;DEPA-KT_h ENT USE ONLY �pp- ------------------------------------------------------ DATE---j 3- -- -�.------- ----------------- APPLICATION ACCEPTED,IBY_--- -= -- REVIEWEDBY-------------- (----- --- -- --- ---- -- ----- _------------------------------ ---------------- --- DATEw-A------------------ BUILDINGPERMIT ISS fb1G_ ---------------------------------- --------------------------------------- - DATE------ ------;;: -9-------------------------------- Alterations and/or rec9g!me ations:-""w --------------------------- -------------------- -------------------•------- = ------------------ 11V F ".�' �( ►�'K' ..- -------------------------- ------- ----- -------------------fir-4! ------------------------------------- -------- --- --- R qIs ------- ------------------------ ----------------------------------- ------------- ------------------------------------ --------------------------------- II +PIN�A� L INSPECTION BY::- - --------- Date_.... -'1�-------------------- --- - - --------- --------------------------- -- - - �• SAN JOAQUIN LOCAL HEALTH DISTRICT 141 1401 E.Haxellen Ave.' � 300 West Oak Street 124 Sycamore Street 405 West 9th Street "+ '41t Lodi,California Manteca,California Tiacy~CalifoI Stockton,California ` F.RCO. 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