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- FF1 E USE: r-'.. ,% �-+ ----------- d "Permit No.APPLICATION FOR SANITATION PERMIT ' �' (Complete Duplicate) �s ----------- - - Date Issued This Permit Exp`iresof*Aakri From Date Issued 7-141� 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 in compliancg3Q h CoyrIfy Ordinance No. 59dig .� — 11�� YY77`F �f�1 .rt r�+ JOB ADDRESS AND LOCATION----- Owner's Name r"?_�_,� `�•, d-- ��1/ L •� s Phone--------- rJ Address------------- Q_1 0i Contractor's Name ...... Phone...I ( R6AO-7 Installation will serve:} Residence [Apartment House ❑ Commercial ❑ Trailer Court F] Motel [3 Other E] Number of living'Units: Number of bedrooms _ _. Number of baths --y Lot size --------------- Water Supply: Public%�ystem ❑ Community system ❑ Private [ Depth to Water Table _j4�0 ft. f Character of soil to a dep h of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [3Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date___.___- ] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,ta�nk or-cesspool permitted if public sewer is available within 200 feet.) k ------- Material----6�5 7_. 47 Septic ' Distance from nearest well--�_____Distance from foundation__lG�_ �f L7 Size_�iriP.- �/Y Liquid depth----:-_,=� `eM--- p Y ,aa9--- No. ofdcompartments._____ �r--__...._ Ca acit � _- 1410 Dis osa Field: Distance from nearest well---S�?._....Dstance from foundation._ d_ ----____.pistance to nearest lot line________________ p Numi 6`of lines__________ _______________Length of each line____,/�D.F0_ '~-WWidth of trench....-___ _._`, Type of filter-material_ '_ �G�K__-Depth of filter material_ ..._..Total Seep Pit: Distance to nearest well__ ��___-___Distance�,f/r°m foundation______`_____.Distance to nearest lot line__A7--__.._ Number of pits....- 9 _ .. Depth-- --��t- -• Linin material___ fir _ -Size: Diameter.____ Cesspool: Distance from nearest well __________Distance from foundation._..-._._.. - ..Lining material-,--..___- ❑ Size: Diameter.-.-.- Depth ----- __Liquid Capacity___...---- ----gals. Privy: Distance from nearest well.---...._-________________________________.__-_Distance from nearest ❑ Distance to nearest lot line ------ ------- ------ Remodeling ----Remodelin and/or re airin describe --_- ._3_ -/•- ' ------- ---------- -------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County''. i ordinances, State laws,-aad rules and regulations of the San Joaquin Local Health District. (Signed)_--_. C.-„ f. wne and/or Contractor) By:._..------ -------- -- ---- (Plot -- [Title) < (Plot plan, showingtsizeof lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... - - - -- - -- - -- -- - •--------- ------------ DATE-----�-- ---��.--------- --,i�-----_- REVIEWEDBY----------------- - DATE------------•------------- ------------------ BUILDING PERMIT ISSUED--------- – DATE.......____----mmmmm------m_mm -- -------- --------- Alterations ATE---------------_-------------------- Alterations and/or recommendations:._.----- -•---•------ FINAL INSPECTION BY: ' _ _ Date. ' SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca, California Tracy,California J F.P.0 C.