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FOR OFFICE USE: ------------------------ ---------- --------------------- -------------- ,"�PPLICrTION FOP, SANITATION PERMIT Permit No. (Complefe in Duplicate) - -------- ------------------------------------------------ Date Issued 4/n�i ,�--------- This Permit Expires I Year From Date issued jol -------- ----------- - -- -1 Application is hereby made .to the San Joaquin Local Healfh District for a permit to construct-and install the work herein described. This application is made in complian With County Ordinance No. 549. R 02-3- 1-70-06 JOB ADDRESS AND ION- 41 .. Phone(�-- ------------- Owner's Name- -- -- -- --- --- --- -- ---- -- -------- --- - ----- --- ----------- ------------------------------- Address------------- .....V. oo-f--- ---- ----------------------- ---- --------------- ------ Ph one- Contractor's Nam - - -- -------- --------- ---qU - ----- ------- ----- ---- ..... ---------- ----I---- Installation will serve: Residence Apartment House E] Comm ial E] Trail?r Court El Motel 0 Other [I Number of living units: Number of bedrooms --- ---- Number of the /-,,Lot size ----- -------------- Community system C] Private ;;De�fh to Wafer Table fo ft. Water Supply: Public 1V------ Er'TTa-rdpan El Character of soli to a depth of 3 feet: Sand [] Gravel El Sandy Loam 0 Clay Loam El Clay L] Adobe Previous Application Made: (If yes,date-_-_- -------------) No F-1 New Construction: YesW��o Ej FHA/VA-. Yes [I No 0 TYPE OF INSTALLATION ;AND SPECIFICATIONS: (No septic,tank-or,cesspool-permitted,if-public-sewer-is-available-w-ithin 200-feet.) 4, from nearest we from foundation - '----------------- I - --------- Septic Tank-. Distance depth_- ..- -P--a--C,i;y -4 - - - - -- Liquid ep�h ---- ---(6 No. of'compartments__.- --------- omearest lot line- --©_. Disposal ine- D;sposal Field: Distance from nearest well... Distance from founda,�,on-- --------- ------D ------------- ------- Number of lines-- ------ --Length of each line ------ Type of filter material -Depth of filter material-. -Tatal length--- 0.t9-e------------------------ -2- ----------- r Pit: ell- ---Distance ojounclationAC6 6--.Distance to nearest lot line.,, zf, Seep I Distance to neare w ---- If t------Depfh-Alr"�------------------- - material- .... Size: Diameter-,-Q.,V- -.---- Number of pits- ------ -------Li ' g Cesspool: Distance from nearest well-----------------Distance from undation----r------------."Uning material------------------------------------- 11 Size: Diameter------ ---------- -------------------Depth-------- ----------------------- -- -----------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------- ------------------- ---- - --Distance from nearest building---------------------------------------- IN11 Distant"e to nearest lot line------------------------ --- - ----------------------------------------------------------------------------- -------------------------- ❑ Remodeling and/or repairing (describe):-------- - --------------------------------------------------------------11------------------- -------------------------------------------------------- -------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------- ----------------------- ----------------------------- --- 1�- - , - ------------------------------------------------------------------------------- -------------------------------------------- ------------------------------------------------------------------------------------------------- -------------------------......... ----- I hereby certify that I -- ------- ----------------------------------- - ----------------------- ---------------------------------------------------------------------------------------------------------- .have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, _%rules and regulations of the San Joaquin Local Health District. P,: Si Wed ---------------- --------------------------------------------------- (/or Contractor) gLp7-jC TANK SERVICE ---------- ---—---------- -- --- -- .... .. -- --- ---- -------- ------------- ------LO to e+ can be placed on reverse side). size of lot, location of system in r�elation to e s, buildings (Plot plan, showing s* FOR DEPARTMENT USE ONLY ----- 71? 1--- ----------------------------- APPLICATION ACCEPTED BY--- ----------------------- DATE 41 --------------------------------------------- REVIEWEDBY----- ------------=------------------------------------- ------------------------ ------------------------------------------------------- DATE------------------------------------------ ----------------- BUILDINGPERMIT ISSUED-------------- ----------------------------------------------------------------------- ----------------- DATE------ ------------------------------------------------------ Alterations and/or recommendations: - - -------------- ----------------- ----------------------------------------------------------------------- ------------------------------------- -------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------- ----------------------- ------------------- ---------------- -- ---------- --------------------------- --------- - -------------- ------------------------ ------------ ---------------------- ---------------------------------- --------------------------------------- ---------------------- --------------- -- ----------------------------------------------------------- --- --------------- -------------- FINAL INSPECTION BY:--..4-- --------- -------------- --- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California