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FOR OFFICE USE: permit No, .�•�-------••---- APPLICATION FOR SANITATION PERMIT � , -------------------------------- ---------- ---- ---------------- --- --- -- (Complete in Duplicate} Date Issued __f:----- ----- ------------- --"----" ----""-"- This Permit Ex:tires 1 Year From Date Issued ��_� 4 -_•___•------- ----------- ------------------------------- i the San Joaquin Local Healfh District for a permit to cans eruct � insta the work herein describe p,pplication is hereby made to , This application is made in compliance with County, Ordinance No. 549. __.. ------------- --- ------------------ . n ----------------- ------ 1?tib - v Phone---- �---------------- JOB ---•--- JOB ADDRESS AND. LOCATION.------- -------------- �• `�f --------- ------------------ - -- - ----- V'1 -- Name l fj�J ------------------------- Owner'sPhon------------------- n--?-------- --- Address.-6-�Q------_ -------- -----�--- - El l ----- - ---- � Mote4 ❑ Other Contractor's Name-_"__.-._e_.- n------- Commercial ❑ Trailer- � (� A artment House ❑ Installation will serve: Residence ❑ P } -_ Number of baths _ --- Lot sae t Number of living units: �--= Number of bedrooms �epth to Water Tableg,q ft. Community system ❑ Private _ Hardpan r,6 Water Supply: Public system ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ^dobe Q F `I ❑ �, No �, C' Character of soil to a depth of 3 feet: Sand ❑ Construction: Yes 0/ ❑ FHA/VA: Yes ❑ ew C Previous Application Made: (if yes date_._"_.:----- � �--1 ° NS- 1.,,,�-:T-YPE*OFriNSTALLATION�ANI) SRe mF Tf public sewer is available within 200 feet. / Y '. (No.septit.tank or cesspool p rMaterial_ ------- '//s► pistanc� from foundation_- - Ca ncit -112 - Li uid depth-----�-- - P Y Septic T Distance from::�nearest well- -------------- I No. of compartmenfis,_._-o�.---- Size. -� x q ! S Distance to nearest lot lire_. r Distance from foundation_- ---- Letan f each line " Width of trench.__ -..--- Disposal d: Distance from nearest Well-SV-1 / 1 6C). i� Number of lines-----/----- es -------Total length--------------- " I `j► Oe ---De. th of filter. mater al--- -- Type of fiiteri i ateria---_- P - /-._.Distance to nearest lot line------------- materia om foundation_, Q-= / Distance to nearest well__��-------- Size: Diameter . ------ -------pepth. S- Seepage x I `�-----------Linin material . _� Number of pits-- - -- g - Distance from nearest well---------------=Distance from foundation ---------_---_._Liquid Capacity_ --------------------------gals. Cesspool: r _-- ❑ ------ - --- ---- Depth --------" .--Distance from nearest building------------------------- 0 ----------- ---- ---------------------- % Distance from - -- PrivSize: Diameterm nearest well. Y ❑ Distance to nearest lot line--------------------- ------------------------------------------------- Remodeling and/or repairing (de scribe):-------- --- --------------------------------- - -------------------------------- ---------- --------------------------------- -�-- ------ - --------- --- --------- ---------------------- --------- -------------------------------------- ------------- cr -- - --- ------- ---' - application and that the work will be done in accordance with San Joaquin County ----------------------------------- I hereby certify that I have prepared this app ordinances, S e law and rules nd r gulations of the San aquin LocaI Health District.{ ,( vrner n�or Contractor) -- - ------ (Signed] .- -y- � (Signed)---- r -' »�-^• LL--T�� ( on reverse s —By.�------ showing size of lot, location of system in r .ion to wells, buildings, etc., can e p (Plot r t t FOR DEPARTMENT USE ONLY DATE_-�-=�7- rG-7------- ------------------------- APPLICATION ACCEPTED B' - - - - —-------- --------- ---------------------------------------- DATE---------- -"---------------------------------------------------- REVIEWED - --- --------------------- ------------- ---- ---- ----- ---- ----- -----•----- ----- ---�-- --DATE-------------------------- REVIEWEDBY--------------------------------------- --------------------------------I PERMIT ISSUED nclati - ------- ----------- ---- ---------------------------- Alterations and/or recommen ations------- -------------------- -------- •------------ ------------- F ---- ---- --------------------- ----------- - - pate --- --- -- - ----- F1NAL INSPECTION BY• _{" - ( SAN JOAQUIN LOCAL HEALTH DISTRICT } 205 West 9th Street 124 Sycamore Street f 300 West Oak Street Tracy,California 1601 E.Ha:eltan Ave. Manteca,California Lodi,California i Stockton,California F.P.r,C]• -