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FOR OFFICE USE: oo�� ------------------ APPLICATION FO`R�SANITATION PERMIT Permit No. -?n rZ,_-6" >------- ------�_ --------- ---------------------------------- - ------- (Complete in Duplicate) Date Issued .�_ " This Permit Ex ires 1 Year From Date Issued ------------------------ ------ - ----- -- -- Application is hereby made to the San Joaquin LocaOHealtr i rh District for a permit to construct and install the work herein describe-. This application is f a e inL co liapewith r `� '7 JOB ADDRESS ON___-•-_ " ----- -- -j -------^---f- ----------- -- ---------- ---------------------------------- Phone - !44 Owner's Name - ---- "-----•--•---. ldk- ,�, '- ------ ---- Address_..------•--- -- --------- ------------ Con#ractor`s Name---- ;;,-------=------ ----- Installation "--- ---- Other _ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Installation`will serve:�Residence,r[WKApart ent House ❑ / Number of living units: --I---- Number of bedrooms -- -- Number o baths - Lot size-1_01744A ''------------------ ------------ -� Community system ❑ Private [Depth to Water Table ft. Water Supply: Public system ❑ Adobe{Hardpan ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ No El Previous Application Made: (if yes,dote---------------- 1 No F1 New Construction: Yes ❑ No E] FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well. -------Dista�1 ce frgm we ffou dation---j_ Material- '` Sep/ca/nk: f#s'S' � x ° Liquid depth--------------------------Capacity--- ------ No, of compartments------Q--------------Size-- --1f--,9-,s-yj—oL- V a 0 Dispos Field: Distance from nearest well-__�,��.-Distance from foundation_-.-�-�.--�-�-Distance to nearest lot line-.�--_------- ------------ ----Length of each line--�P '.�- ----Width of trench---- -- --.----- Number of lines_--------" - Type of filter material------.�-n --�----Depth of filter material------ - f.--.----Total length---- Type of ------- j ---:- Seepa Pit: Distance to nearest well--_-�. ------- Distance from foundation_-/-.Q--__-_.---.Distance to nearest lot line-__ • t Size: Diameter.-.--3.3-�. ----Depth..... TS-�"------- Number of-pits_..__-.�----.--Lining mc . - I r Cesspool: Distance from nearest well-----------------Distance from foundation----------- -------Liquid Capacity-__ --gals ❑ Size: Diameter ----Death--- .� i� Distance from nearest building _ - . —. _ Privy: Distance from nearest well---.-." - r�" "'� x Distance-to-near-estrlo+Yline--=-------=-----�-----_-------- ----- - a Remodeling and/or repairing '(describe)------------------------------- ------------------------------------------------ -1--- ------- -- -- - --- ----- - - ---------------------- --------------------------------------------------------------------- hereby certi- -- fy tha- - -- - t I have prepared this application Saalndthat ha-th-the Healthle done {n accordance with San Joaquin County ' ordinances, State Ls, d rules and regulations of the q and/or Contractor) ---------------------Si ned - ---------------- ( 9 } ---- ---- --- - ------- -- ----- o of system in relation o welts, buildings, etc., can be place on reverse side). Y (Plot plan, showing size of lot, location FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _ ---�----- -- DATE--` w ------------------------- -- --------- --------------- ----- ---------------------------------------------- DATE--=--------------------------- --------------------------- REVIEWED BY----------------------------- - DA BUILDING PERMIT ISSUE ---------------------- ,-- -------------------------------------- - Alterations and/or recommendations-------- --------------------------------------- ----- --------•--------------- -------I"----"- ------------ - -------------- ----------------- -------------------------- ------- ----------------- ------- Y ------- Date----- ------------------------- --- ---- =- - ------- --- ---- -- - - - FINAL INSPECTION BY:-"-------------'�- -•----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1Fa=ellott Ave. 300 West Oak et 124 sycamore Street 205 West 91h Street Lodi,California nia Manteca,California Tracy,California Stockton,california � c -