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FOR OFFICE USE: y sem, PPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --,1 7,14•-r ------ This Permit ExiDires 1 Year From Date issued Y Application is hereb d. made to the San Joaquin Local 0 dealtn District for a permit to construct and install the work herein describe This application is made in compliance with County --.----------------------- JOB ADDRESS AND LOCATION------ 5... ---- Phone--------------------•--------------- Owner's Name----------- J ---•------ ----------------•--------- --------•-------- Address----_--- -----•-• - - - ---- -- ----------------- 14-e -----•---•---- I .e__._. Contractors Name__________ _______�----- Other w►A artment Nouse ❑ Commercial ❑ I Trailer Court Motel ❑ ❑ Installation will serve: ResidenceT[( p -.: Number of living units: __Number of bedrooms _�IVumber of•baths Lot size ._ - -- Water Supply: Public:system ❑ Community system ❑ Private X Depth to Water Table�0 ay ft- Adobe Hardpan ❑ { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam o. . ❑ ' ... NoA,. New Construction: Yes' No,❑ FHA/VA: Yes ❑ Na� Previous Application Made: (If yes,date--_.___.__,_. -- 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i r Distance from-foundation _. - __-_____'.Materk�--._ . ------ „ �,�, Septic Tank: Distance from nearest well -- - Lsquid depth_______ .-----------Capacity.a2_�-- 1 No. of compartments._-____ -----------Size___. - -� 1 ` /4 '- ._---_--____Distance to nearest lot line._____..____.._. Disposal Field: Distance from nearest well._s2.------Distance from foundation_____ " __Length of each line------� -- --------.Width of trench---.-o�--�-•------- Number of lines g r� q- �- Type of filter material-_-,— --- Depth of filter material-__� -----/----Total length___ ----- - . .. l f0 Distance_to nearest lot line-- tSeepage Pit ""`Distance_to neareswell_-��d- -----:Distance fr m fo nds zE n"Diameter------ - ---------Depth� Number of pits---".�--------= Lining material-_-�-- Diameter Depth------------------------------------------------------. Lining material - Is Li uid Ca acit gals. t Cesspool: ' '- -Size: Distance from nearest well._____.__-__.__-Distance from fou,ndation_____._.-_- q p y ❑ 53ze:`Diame i ._Distance from nearest building.--:--------------------- Privy: Distance from nearest well--------------------------- ---------------- -- •-------------------- � Distance to nearest of kne__.__-------,-----�- - l Remode4ing and/or repairing (describe : - -------------------- ------ 1 _ - --------------------------------- s -- --------------------- ------------------------------------------------------------------------------------------------ ----------------------------------------------•--------•-- ! - --------------------------------•----------------------------- I her eby certify tha ndfirulespandaregulations of the San Joaquin Localwork Heawill ltfieDistric}n accordance with San Joaquin County # ordinances, State laws, a -----------------------(Owner and/or Contractor) T St pled _ - (Title}- k By:-------------- - _ !��'�"-S'------1��.'�. - --- - i (Plot plan, sfiowing size of lot, location of system in rely ' n we11s, buildings, etc., can be placed on reverse side). — FOR DEPARTMENT USE ONLY Y____-- -- iL(- - - -y DATE----- ----------------- APPLICATION ACCEPTED B ' - ---- ------------------ - DATE_-.- -------- ------- ---------------------- --------- -- REVIEWEDBY------- ------------------------- ----------- ----- --------------------------------------- ---- DATE-----------------------------------.------------------------ BUILDING PERMIT ISSUED-------------- ------------------------ ------------ ----------------- ions______________ Alterations and/or recommendat _ _�-{-- - -------- -- c - � ---- - '- ---- _ r, _ -- -- "lam" ------ --------- ------- ------- h - -------- -------- `� r` -- FINAL INSPECTION BY:.. /1. Date... t � SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 west 9th Street Lodi, California Manteca,California Tracy,California Stockton,California F.P.ru. 1