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APPLICATION K SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application pplication is hereby made to the San Joaquin Local Health District for a permit f vc nst!'ucf and install he work herein described. is�aPp,licafion-is-made,in-cornpliance with-County Ordinance jo. 54 (7t. OB ADDRESS A LOCATIO ------- .. .... ------------------------------------ - Owner's Na ---------------------------------- ------ ---- --- ----- ---- ------------------------------------- �one - ------------------- Address---- Contractor Name---,�, ---------------------- Phone IR -'-r ------ - ------------ ---------------------------------------------- ----I-------- Installation will serve:.,'Residence 0 Apart enf House F-1 Commercial Trailer Court ❑ Motel Phone E] A (Xl Number of'living units: --/--- Number of bedrooms I_ Number of baths -1--- Lot size ---49X- -/0 ---------------- -- --- Water Supply: Public system Community system E] Private D Depth to Wafer Table4e�4?ff. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Clay [] Adobe❑ Hardpan E] Previous Application Made: Yes Ej NOX New Construction: Ye� No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) eptic IN Tan Distance from nearest well-----------------Distance from foundation_____________-__ Material-------------------------------------------------- al F* No. of.cornpartmnts--------------------------Size--------------------------------Liquid depth------------------------- Capacity----------------------- ;s Distance from neaerest well------ ..........Distance from foundation--------------------Distance to nearest lot line_____.________.. ' Number ine----------------- Number of lines-----------------------------------Length of each-line-----_------------------------Width of french----------------------------------- Type of filter material________________ -----Depth of filter material_________..__--_____.Total length________-_______._______-_._...,.______- - Se ength------------------------------------------ Se e t Distance to nearest well-,,?t-,0r—__-__Distance ndation----�-/ -------D'sitsince to nearest lot lipp-F -------------Lining materiaSize: Diamefer-;ky... Depth-- ..-PU---------------- Z I el ---------- spo D*sfance from n aresf�we�L-4--—-----Distance from foundation----- ____________Lining material---- Sizw:'Diameter-----: -- 4L / - ---------------------------Liquid Capacity-.-----2-0.00------gals, ... ...........Depth------------------5-1 "Distance from nearest well--------------------------------- y: - --------------Distance from nearest building------------- ------------------ ------ - El A Distance to nearest lot line--------11----- --- ------------------------- ------ --------- --------------------------------- -------------- ---------- Remodeling an ai"rin _(clescribe):------ -------- - ----- -------- ----------- --------- ----- - ------ ----- --------------------------------------------------------------------- --- -------- -------------- -- ----- ------- -------------------------------------------- ------- ----- --------- R Remodeling an emo ell g ------- ----- and -------------------------------- -•--••------------- ------------- ------- - -- --------------------------•----.----------=------------------ ------------------- ------------------------------------------------------------------------ --------------------- ---------------f------------------1----------------------------------- y --------- --------•------------------------------------------- ---------------- --------------------------------------*-------------------------------- hereby certify that I have preparecl this application and that the work will be done in accordance with San Joaquin County r or n nces, Si WS1 es i na afe,�a d I md reTiat�ns of the San Joaquin Local Health District. (Signed)-------- ---- (Owner an Contractor) ----------------------------7----------------------------- ------------ ---(Owner an By:---------------------- I-);V/'/J� - (Title)----- -- --------------- -A------ - -I-0-f. lot, tion to wells, buildings, etc., can be p ac on never side (Plot plan, showing size Iota n of system in relation FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- — ------------------------------------------------------- DATE f;;, - -- j --------------------- REVIEWED BY------------------- - f ----------------- -------------------------------------------- DATE------------- -------------------f BUILDING PERMIT ISSUED =-------------------- 4,7 1 - - ---------------------------------------------------------------------------- DATE----------------------------------------------------------- - Alterations and/or reccmmendations:---------------------------- ----------------- ----------------------------------1k--------------------------------------------------------------- . 1. k li� ---------- ------------------ ----------------V�--- ---- - ------ -- -------- ------- -------- ------------ --------------------------- -------------------------------:---- •---------`------ -------------------------------- ------ ---------------------- ----------------------- ------------------------ -- ---- - --------------------------- -------- -- ---------------------- ---------- ------------------------ ---------- --------------- -- --------- ---------- -- --------- ---------- -----4------;0&/-- ------------- --------- ----------, -------------- ---------—----------- ----------- ------------------ ----------------- ----- t�D fNAL INSPECTION BY:-_-__'__ ---------------------------- Date.------1------- r SAN ate-------SAN JOAQUIN LOCAL HEALTH DISTRICT /110 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100