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FHp I FOR OFFICE USE: Permit No. APPLICATION FOR SANITA�'lON PERMIT -- ---------""--------------- ' (Complete in Duplicate) I - Date Issued -1 __.. .. This Permit Ex fires 1 Year From Date Issued I --------- -- -- I Application is hereby made to the San Joaquin Local Healf DiNoc for a permit to construct and install the`work herein described. This application is �ad.e,incompliance with Count Ordinance Y Phone--- I JOB ADDRESS AND LOCATION_+.---- �-�--�-�-- --------------�--`�-'�---------- - -Y-''�-------------------------------------------------------------- --------- ------------ ------------ -----•- I Owner's Name------------`� F3 �t`_d- , Address_.._..____-'-��.p-�----•-�`�`_�-�__��--f-�-------��`-�---•-------------�-------==-•----•------- ---------------------------•----------•-- --•----••----•-----------•---------------- lL01 - Phone. .. - -------------------------------- - - -�----------------------------------- - -F' '�`_____`_�`"_.'�_ Motel ❑ Other ❑ Contractor's Narne____ _ Apartment House ❑ Commercial ❑ Trailer Court ❑ I Installation will serve: Residence`�'AP ------- �_ Number of bedrooms �__ Number of baths I--- --- Lot size ---�J Q-�--�-�'-----••----•-- ---- ------- Number of living units: _� Private ❑ Depth to Water Table -------- ft. Water Supply: Public system Community system '❑ Adobe 23--Hardpan C1haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑FHA/VA. Yes p— No 0 C New Construction: Yes ®° No E]Previous Application Made: llf yes,date------------- NO I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C � Distance f om foundation----1P----------Mater Capacity $ � Septic Tank: Distance from nearest well-_.�` .3� f Liquid depth_ --- " No. of compartments--"-.--2----------- Size._.. ----- l I Distance from nearest well__-._ -------Distance from foundation_._ _y I.------ Distance tfttrenchest I�ot!ine=_��-- -------- Disposal Fi Id: __--Length of each line__._---: --- f ` ' I Number of lines------------�- ---- - g Total length--------`f- l i Type of filter material.: "c------Depth of filter matenaL"_..1 --------- i I Seepage Pit: r - Depth ------------------- P Distance to nearest well_._-.--:--- - Distance from foundation____ �`--•-----Distance t° nearest ofline--.--?-"-------�- -_._-Linin material __.Size: Diameter__�'J--- --- - P Numberof pits-"-.----I--- g ------------------------------------- Cesspool: r Distance from nearest well---- - - ---Det}hce from foundation--_----�-..---___-Liquid Capacity__.._.___._______.___.___gals. Cesspool: ❑ Size: Diameter----- -------------------------------- p i Distance from nearest well---.--_------------------- ------ ----------- -Distance from nearest building Privy: ---------------------------------------------------------- - -------------------------------- ---------❑ Distance to nearest lot line------------------------- -- - � I Remodeling and/or repairing (describe}-------- - ---- ----- ---------- -----------------------------------------------------------•------------- iI---------------------------------------------------------------------------------------------------------------- 1 ------- ---------------- -----------------t ---------------- --- --------- ---- -- ---------------- ----------------------------- -- .� ----------------------- l - nd that --------- ------------------------------- I hereby certify that I have predparedu��t on ae San Joaquin Local kHealtheDistr cidone n accordance with San Joaquin County ordinances. State laws. and rules an g � ` fi (Owner and/or Contractor] I (Signed) ------ -- - E -- --- ------- By:--------- . (Title}------------------------ ----- ----- ----- -- ,. t (Plot plan, showing size of lot, location of system insrelation to wells, buildings, etc., can be placed an reverse side]. R FOR DEPARTMENT USE ONLY ' DATE-- �/ ^�. 1 APPLICATION ACCEPTED BY_. c__-# ---------- ' REVIEWED�BY.------- ---�-- -----------------�------- --- -- ------- ------- ------- - ------ -------- ----------------------------- DATE----------------------------------------------•------------ BUILDING PERMIT ISSUED------------- ----'------------ -------------------------- -- ---------------- DATE = Alterations and/or recommendations: 33 X ' " ' 't _ - ---------- ----------- -•------- ------------------ ------------------ t }. ---------- ------------------------------------------------ --- --- ------- ------- `" -- --- ------.- ------ ------.-------- ---- 4 k f� Date----------Z_-. .- - --- "-K� - FINAL INSPECTION BY: ---- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street y 205 West 9th Street l � Manteca,California Tracy,California Stockton,California Lodi,California .