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Lp,OFFICE USE: : Permit No. ..-•• /�`.� APPLICATION SANITATION PERM IT --- --------- ` == % Duplicate) Date Issued •--- 7 --- (Complete in --- -�:- This-Permit Exfres 1 Year From Date Issue--� --- ------ - � " " - ermit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Healfh District for p I y ----------------------------- This icatapption is made_ in compliance with County Ordinance No. 549. / s-.=_ � ---------- LOCATION �' ,-- �-- -- ---------- -- Phone_------- - JOB ADDRESS AND ___f -------- ------------------ _-_ Owner's Name----------- = I- ------ ------------ ---------- , '' r ------------ AddressPhone.,¢rl� t ----------------------- .. !. j .��-•-•--�--� - -_- - - - Other ❑ ' Trailer Court ❑ Motel ❑ Contractors Name___________ __• -- art ent House ❑ Commercial ❑ j--- Lot size ---lopox loi4- . installation will serve: ,Residence p 1Number of baths Number of living units: ---INumber of bedrooms ""Private Depth to Water Table �Q it. El system ❑ [�Cla Adobe❑ Hardpan ❑ Water Supply: Public system No [•7r F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Y FHA/VA: Yes ❑ I J No [� New Construction: Yes ❑ No [� �. Previous Application Made: (if yes,date------------- ----- TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.)" Material------------------------------------------------- Distance from nearest weil--------------- _ = Li ui-- depth__.-----------------------Capacity---------------------- I Septic Tank: Size------------------------- - q No. of compartments___-"-------- ❑ r Distance to nearest lot line_________________ �_"__Ditance from foundatio �------ f/ Width of trench___ _"" ----- = s Disposal Field: Distance from nearest well.__ _8 - � 0 �1 ftfl Number of lines------- ---------Length of each line" -_.___ Total length___.__ Type of filter. &1-0 of filter material-" ( r Distance fr m foundation__.____."-------- Distance to nearest lot line w , J x Seepa�Pii;' Distance to nearest well/L'�---"---- S� Size: Diameter__��----=- = DePtn_."- - ---- L,�•. pfd Number of pits--- -------Lining matenaL." �'e<�' Distance from nearest well__--------------Dist+Ince from foundation __------ Lisquid Capacity_.____ ------ gals. W I Ces ook __.De %A ,❑ p 5ixe: Diamete[r---------------- ---- ---- -- -- - _Distance from nearest building----------------------------------- ------------ ---- ---------- -- - s 1 a Privy: * Distance from nearest wet - ❑ � Distance to nearest lot line------------------------ ----- ----- ---------- Distance --- --- - •-- ----------- zxv--------------------------- £ Remodeling and/or repairing describe): ----- --- ----------------------------------- ------------------------------ -------•---------------- --------- ----------------------- i done hereby certify that I have prepared this application San Joaqui hL cal HealthEDi District. ,accordance with San Joaquin County ! he Y les and regulations of h ordinances, State { wand/or Contractor] "ter_ (Signed) f (Title]""-- ----- et ------- • ,,.�- (Plot plan, showing size of lot, 'location of ys+em in'relation to wells, buildings, a+c., can be place on reverse s1 e. , FOR DEPARTMENT USE ONLY (�. DATE........ 1 r� DATE------------------------------------------ -------------- ----------------- ------ ------------- APPLICATION ACCEPTED BY------------- -----------------------. ---- -"_-- - - ----------------------------------- REVIEWED BY--------------------------------------------- ----------- --------------------- ----- --------- ------- —+'' �----- ---- I3UILDING:PERMIT ISSUED--------------------------------------- ---------------------�---- ----- -- ------------- -----�,�---~-�'- "-- Alterations and/or recommgndations:__._._.,__ -�. -- ../l`� ------------------------------ -- -- --------- ------------- ------ ---------- ...-- ------ ------- ------------------- E ____________________________ Date--- -+.'.-(A, --- ------------------------------------ FINAL -- - --- -- --FINAL INSPECTION BY: .--�-� , ` ----- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 205 west 9th Street 124 Sycamore Street 300 West Oak Street Tracy,California 1601 E.110:e11on Ave. Lodi,California Manteca,California , Stockton,caufornia F.P.CO.