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FOR OFFICE USE. - ------ - - - �? APPLICATION FOR SANITATION PERMITPermit No. (Complefe in Duplicate) / .. Date Issued This_Permit-Ez ires..1 Year-Froiiri_Date Issue0 05,q ^� Application is hereby made to the San Joaquin Local F-lealth District for a permit to construct and install the work herein described: -- - - This application Is made in.e-o-m-Bance with County Ordinance No: 549: G� kl - - - - - JOB ADDRESS AND LOCATION. lt_�a��:_ P: P .�G.�� ::..••��_ 1:.�lfl' .:_,::::1'— Owner's Name :___� ::::: .__1e.:::..aGe r:::.:._.--- ...... _ _ _ Phone:...:..:......... .........:.::.... Address. --- -----: ------- •- " � ...'Li�----- •--_--_------•------------------------------ :: Contractors Ntime:::::::::::..::::::�f�T..li�tl�J--:T��:.---_•_•----::::,=-__-_•_--- --�----_ ... _ _ . one In`stalla4ion will sen►eE Residence elApartfnent )"louse 0 Commercial Trailer Court Mo#eI Other 1 Number of living unity __L Number of bedrooms Number of baths Lot sire i Water Supplyt Pubiic "system [] Community system Private tap#h to Water Table Ckerac4er tit soil 46 a dep4h of 3 feet: $and tj Gravel �] Sandy Loam ❑ Clay Loan [ Clay �]" Adobe Y� Hardpan Q Previous Applica4ion Made' (If yes date.::...:..........:..i No 8 New Construction: Yes ONo 0 FHA/VA; Yes 0-"No ❑ TYPE OF INSTALLATION AND SPEOPiCATIONSs i (NO op41c tank & cesspool perrni}#ed if public sewer is avallable within 200 fest:),. - i - - Septic Ta-k: Distance from nearest jel _: _=,=--Distance fromfoundat;gn._ p= ..:---.Materiel=:= f' •::_No: of compartments-__ _::---------- Capace.flR ---'quid depth_,::: -- ::... Disposal Field: Distance from nearest well-_"_ Distance from foundation::�1�1__:_:::::Distanee to nearest lot Ilirie:. .......:::::. Number of lines==------ -J- --- --------- Length of each lihe___.:.:7 ..Width of trench-.... .::: .. Type of filter material./.�-1ee Depth of filter material-__.1 =._____:_Fetal len'g'th--_-.Z-t ::::::__- Seepage Pit; Distance to nearest well__452x_____.Distance from foundation.:::.�p......Distafce to nearest lot line.............:: -__Lining material,: f�fs/Lf...Size: D'iarneter:, •3:.::r=-,,,.Depth=z-Aw;�: .................. Number of pits______ ____________ , ' Cesspool: Distance from nearest well.________________Distance from foundation._:..._.___..::.:==:Linin- material.:.::,,,,........... .•+'• Is. Size: Diameter-------::-.:..:.,_: ...---Depth=:---------....:........::.:.::......: 1 ci ...._....... ci .Liqu'd Capacity .. a Privy: Distance from nearest well------------------------•--:,...----•--•_---••---Distance from nearest building Distance to nearest lot line---------- -----•---.:,:,: «....,. ... rie --• • - ...Remodeling and/or repairing {desc � ). ^, ............................... I Hereby certify that )'-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules 9nd regulations of the San Joaquin Local Health District. ` ........ .... (Signed}:::........::::::...........•---:: ....._..... .._, ...-----•- - •- ••----...... By:..... .......... - .......-•---.......,....-----••-,... _ _ �,�' • _ �..{Title). --. -�_. (Plot plan,showing si:e of fol, location of system in relati o wells, buildings, etc., can be placed on reverse tide]. FOR DEPARTMENT USE ONLY r� / APPLICATION ACCEPTED BY.-•---...........----------------------------.----._-.---•- ---- f:. x - DATE------- / �Ca.. REVIEWED BY......... ------------ - DATE_'...._.....-----••-......................-----..I......__. -------•---------------- BUILDINGPERMIT ISSUED................ -------------------------------------- ......----- DATE..................................__....-------------------- Alterations and/or recommendafions:_ -_-------------• ----------------•- ----•-•-•---••--•-----•••........................................................... - FINAL INSPECTION BY: ._. . _ ---- Date.-- 7.� :\.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americadstriof 4100 West Oak Srreet 1.24 Sycamore Street 205 West 91h Street Stockton,California Lodl,Caiifoinla * Manteca,-California ? Tracy,California ES 9 REVISED S-99 RM E-61 At CA9'