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FOR OFFICE S'<'• a - -------------------- �_ _' ?_�'_.__- APPLICATION FOR SANITATIOt. PERMIT Permit No. .-�.A-_��_ ------------ -----`--- (Complete in Duplicate) /f -- -- ----------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is made 5"in compliance with County Ordinanc No, S49. JOB ADDRESS AN OCAT O _ �f Owner' N e - -- ----- Phor}&`G •1� Addres �`� •- ----- ----- -- ---••-- •----- --' ---------i-------- ---- ------------- - ------- -- - -----...-.... Contractor's Nam ---- --- --=-----•---- - -- � ---- ------- ----- --- - --- - - ----�------ Phone---•-----------•--•--...----•----•- Installation will serve: Residence ❑ Apartm nt House ❑ Commercial Tra' r Cour} R- �o�tel Other Number of living units: -------- Nub r-of„bedrooms..------- Number of baths -------- Lot size / _----------------_------. Water Supply: Public system ommunity system ❑ Private El Depth to Water Table 40ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [� Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe ardpan ❑ Previous Application Made:.(If yes,date-/..�l_ T-..- _J No ❑ New Construction: Yes ❑ No FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _,eO'5TNo septic tank or cesspool permitted if public sewer is available within 200 feet.] I is T45—Distance from nearest well-----------------Distance from foundation--------------------Material ---.--_-.____.------_-_---_--.----...________-. "^`—i No. of compartments------------- ------------Size-------------------------------Liquid depth-- -----------------------Capacity----------------------- posal Fiel Distance from nearest well---A Distance from foundation.-----I-0--`..Distance to nearest lot line--- Number of lines------./_. .----__---..._..-Len th of each line_ - u'/ ��ff 9 �-�-- -------�Width of trench. --4�---'--•------------------ , Type of filter material±4R .1 . Depth of filter material---__ Total length------- ' 1 _''-----_---.._ Wet, Dis#ante to nearest well__!-___ _____-_--Distance from foundation---_-�'_0--__- Dis nce to nearest lot line_-.-�--- Number of pits.-.-/____--------._Lining material---,4�e�-----..Size: Diameter ' Depth-_c�-� ----Distance from nearest well--------------j Distance fro foundation------------------- material--_____-----.--------____-------_--- ❑ Size: Diameter----------------- -----------------r.De M-- ----------------------- -----Liquid Capacity-. ----gals. J Privy:' Distance from nearest well-------------------------------------------------Distance from nearest building..---------------------------------------- ❑ ` Distance to nearest lot line--- -- ------------------------------------- ----------------------- - Remodeling and/or repairing (describe]----- - ---- ---------------- F ---------------••--------------------------------------------------------------------- --------------' w------ ---- of 1 ' -------------------------•------------------------------------ �b hereby certify that ! have prepared this =--------- ----- -------------------------------------------------------------------------------- ---- ------- 3 I application and that the-work will be done in accordance with San Joaquin County p ordinances, State laws, and rules and �41 ulations/�of�the n Aaquin(LLocall I h Distri (Signed)----c �C1�. Ap_ '''c ----- ---- - r-- r Contractor] � By: (Title) - -: : (Plot plan, showing size of lot, location of system in relation wells, buildingsc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__e_"_'11_ _---_ ------------- -----�-�------.----------- --- F fr �- -- ------------------------ DATE-------��--��-�--- ------------ -- ---------- REVIEWED BY --------- DATE BUILDING PERMIT ISSUED---------------------------------� r -- - DATE.------- -_----- --- -/----------�--- -----------!-- ----- Alteratis and/or recommendations: ------ � = — fes. --------------------------- ------------------------------- -------------------------------------- ---------------- --------- --------------------- ------------------------ ...... ------ ------------------------------------------------------------------------------------------ ------- ------------------------- FI NAL ------------------------FINAL INSPECTION BY:...-.(/� --lam _---------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California / F.P.C D. i. w I'