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1-Ull UI-1­1(_L USE: <br /> r ----- .................._-- " 1= 0._-.. APPLICATION--FOR-=SANITATION PERMIT Permit <br /> ........... ............ .. 4 <br /> . ..'..--3=�•- --. (Complete in Duplicate) _ <br /> This Permit Ex ires 1 Year From Date Issued Date Issued <br /> Application is hereby mode to the San Joaquin cal He lfl District for a pe mit to nstry nd insta the yqk heroin descfib—ed.- <br /> i This application Is made in compliance with Co 9, _ <br /> 1 L` <br /> JOB ADDRES AND LOC ON. . <br /> Owner's Name-... ..... .. - <br /> ....... ... Phone... ........................ <br /> r Address <br /> ... <br /> Contractor's Name., .............. .. <br /> ... <br /> -. . � . ....- (.................... Phan <br /> T <br /> Installation will serye: Residence ❑ Apa tment Ffouse Commercial ❑ JrZader Court ❑ M ❑ Other �— <br /> Number of living units: -. <br /> Number of bed ooms _..-_.. Number of ris Lot size / ,-_-... -_� <br /> Water Supply: Public system ❑ Community system ❑ „Privte - Depth•to W J Able .-: ft. <br /> ... <br /> Character of soil to a depth of 3 feet: '$and Gavel-. <br /> ❑ [:eSandy�Loam �Clay,Loam-❑ GI!y-[O f_�dobe❑ Hardpan❑ <br /> .. <br /> Previous Application Made: (if yes,dote ------ ._ --- I No ❑ New Cons uction: Yes ❑ No FHA/VA. Yes ❑ No 71TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspoolpermitted if lc sewer is av3ila61 within.2004,� <br /> Septic Ta Distance from neafesr Wei,,,. Disten e m f ^ '" :" n. <br /> ! .ice t[/a l <br /> tJo. of k ompartmajnt - r Size q iafdetn_. ,. - . 1�,_...Ca.p ---- <br /> ac�ity-{ .... <br /> Dispmosnl Field: Distance from near, st we!i,t�_8. ._--Distance from foundaJt'e'rrzj .Distan�e•to nearest lot line- <br /> V517-11— <br /> I/� Iti'umber, of lines �..... _ _. ..Length off ac.,I:rte J� .--_ 1Nidth,of-t'%_ <br /> tt <br /> Type ofi f:ier mate .Depth of'filt�r, material ,_ _•-•i-_--_-TotAi'�len th..-. _ 1. <br /> .<.� j <br /> Seepage Pit: D'sfance t'o nearest well ------- Distance.Distance from foundation-.-_-...!!r;'.,,.,.Disrar,ce to nearest lot line...._... <br /> ❑ Nur tber of pits..._... Lina: material-.... ------ -ii <br /> Cesspool: Distance from nearest well............._Dis*ance rrOm foundation...._. ..__---_ Lininq materiaf_-.- <br /> ❑ Size Diameter...... . -----..........i.. -- <br /> �1 ---- -.-------------- ----- Liquid Cmparity tgalI <br /> ..m near l ...�� _l- <br /> Privy. VistanCc r est well.-....-,__--- init ` <br /> -- .._.. D`rance rom 7777bar c -- <br /> Di 'ancr to nearest !ot liner.- ....................... .......--- ------------------ <br /> Remodeling <br /> ---..._- •--- <br /> -- <br /> Remodeling and/or rap " fdescri:-:e): . ". <br /> .. ...... <br /> ----------- <br /> - ...----•........................... .. . .. .. <br /> I hereby certify that I have-pre ared t i application and }ha+ the w will'be'i�o`ne in accordance with San Joaquin County <br /> ordinances, State laws;'W rules and regulations of th, an Joaquin Local Health District. <br /> , <br /> N <br /> (Signed)-- .. ....... .4A...._. <br /> - (Owner and/or Contractor) <br /> I....P ---- •---------- .................... --........... <br /> By: PTIC TANK �EFRVICE <br /> E:fiRrner Rve: 0-,.• _ -.... - _... Title. .- . . <br /> ---- <br /> (Plot plan, showing sire of lot, ocatl n o sys em in relation to wells, buildings, etc.,,can„berpleced`on <br /> reverse side). <br /> f —FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..-oz. -ct�ZQ.. = `D' TE----g'S"�<a...--- <br /> .....---------------- --- <br /> ----. --- <br /> BUILDING <br /> BY .................. ... ..... ...... ....•-- ' <br /> _. .......:......--_. -----•-----•-•------- ------------ <br /> -- . DATE- -------- _��......_............... <br /> UILDJNG PERMtT ISSUED .............................................. ... I" <br /> .....---F--r---- <br /> Alterat� $nd/or recommendations:_. ..._..._ ...._..'15 •------DA...._�.." .............. <br /> ._--.-.-- ......................... ........ ... <br /> (/ . . f <br /> . ........ .......... ........................ <br /> ..............._..............--•-•--- ......._.....--..._..._----- ..._. .................. <br /> ..............................---- .... _.,..............._.........------- <br /> FINAL INSPECTION BY:... ..... G.. ._ ._�. ..., Date...... <br /> w..... . <br /> tf` . .... ..... ..... A <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> j <br /> 1601 E.Haxetlon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 Wast 91h Street <br /> Slocklon,California Lodi,California Manteca,California <br /> Tracy,California <br /> r.P.CO <br />