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FOROFFICE USE: `f APPLICATION FOR SANITATION PERMIT Permi. No. . C�7 --- (Complete in Duplicate) ----------------------------------------------------- This Permit Ex fires Year Frvm Date Issued D05 0ate Issued .Application is hereby made to the San Joaquin Local Health District for a permit to corj0rLtcf a install the w r ein descrl ed.� This application is made in,compliance with County Ordinance No. 549. AjJOB ADDRESS AND`LOCATION__ . 3 .__ .._ ___- ._- K-- �(�� Owner's Name a-- - l.t-�Lo �� f 1 Address---- ------- ------------•- - ------ "=-- --- - - -------------- ---•--------=-------•------••----•--------- -----.-. Contractors Na ((, - � �_-----•-------------------- Phone.! �Q. . ---/-� ' Installation will server Resident partm t House- *'.Com ercial-E]""Trailer Court [] Motel ❑ Other ❑ Number of living units: -_ _.. Number of bedroo_mj.-.- Number_ of th`s -_._ Lot size _ _. Water Supply blit system E],Comm'unity system,,.E].,iPriJatg; ,,Depthrto_Wa#er„Table., .ft....r •-s•-��* I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobe -lardpan ❑ Previous Application Made: (If yes,date----------_---------) No ❑ New Construction: Yes ❑ Nq, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -,'(No septic tank or cesspool permitted if public sewer is available within 280 feet.) W T3C S (I� Distance well-----------------.,.......... .......�..D�s.ta.n.c.e�..from foundation ...._..p-�__._- ..,..Mate�rial-------------------------------•--------------.----- - -- -- __Liquid of compartments- 9 ------ --------Capacity-------------.------ os is Distance from nearest wellD stance from foundation-j-Q �__..- Distance to nearest to} e.aa-P.s .1 0 �rNumber of lines______ Length of each lineWidth of trench-. ] *th of filter math----------------_ Q ------- S, p]1 a Type of filter m--i. - Seepage Pit: Distance to neares well__ .IQ .P R � r__-_Distance to nearest lot line Dlstance if foundaton. ____"- i Number of pits.___ _.__._ Lining meteria'I: _ o. . Size: Diameter__ zz ?_ ' + Cesspool: Distance from nearest ill,2 —WILS stance--from=foundation � -_-,_.-_.Lining material--._.--_._._ ____. .-.`__ ❑ Size: Diameter-----------------__---------- ---------------Liq�d Capacity------ - ---------------gals. Privy: building y' Distance from nearest well----------- ------------- --'=_.-.-- _-___-.-_Distance from neares`f building___.__.__._._.._"_..._----__-----.._------ { ❑ Distance to nearest lot line --=----------------------------------------'--------------------------- ------------------------------------------ ----------- t Remodeling and/or repairing (describe)--------------- -- f ---_----"-----------------------"-____-_-__________._-________._--_____.__"________.___- ___ __ � r - = - - I hereby -certify t t 1 have prep•'ed;this application and that the work will!be done in accordance.with San Joaquin County ordinances, State laws pd rules"and,rejgulafions,of�-flie San Joaquin Local Health LDistrict:,.-, eJJa Y/i 1 ht y (Signed)-- - ::. --- ---- - --------------------------------------- -----------(�F Contractor] SEPTIC-TANK $ 2ViC>^ 4U-,...�...,-• — ByQ915. 6-3843-------------------------------------- --: - ---------------(Title)-------------- -- - ------- -- -------------------------- (Plot ------- - --- (Plot plan, showing size of lof�locafion of system in relati to wells, buildi s, etc., can be placed on reverse side). FOR--D. ARTMENS ONLY APPLICATION ACCEPTED BY- --r-- -------------------------- REVIEWEDBY------------------------------ -------------- ---------------------- ---------- --------- -------------------------------- DATE------ -----------------------------•------------------ z BUILDING PERMIT ISSUED------------------------------------------------•-------------•-------- ------------------------------- DATE------------------------------------- -- Alterations and/or recommendafloon�----,---------------- �------------- ----------------------------r" --------------------- -------------------------- r._-----------•- -----•=------ -- a..---- 1 kbR f ..................------------------------------------------.-------------....._......__....._.------------------------------------.---------------------------------------------------------------------------------.._._____ _ L_ A FINAL INSPECTION BY:- Date ----~-�`- SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street •f Stockton,California Lodi,California + Manteca,California Tracy,California F.P.C C.