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i FOR OFFICE USE: Permit No. ..r��-•`-3•- �= ----5 APPLICATION FOR SANITATION PERMIT .. (Complete in Duplicate) Date Issued --------- r?s .' ----- ----- --------------------------" ---------- This Permit Ex fres 1 Year From Date Issued .% ----------------------------- p plication is hereby made to the San Joaquin Local Hdealtrh Dice strict for a permit to construct and install the work herein described. This a lication is made in compliance with County _ PP �E f�7'-49. l2-! p zS S V_ JOB ADDRESS AND LOCATION.. . Phone------------------------------------ 0 wrier's Owner's Name. --- -- - --- ----------------- J -----------•--•-------•-------------------•---- -----•--.-..._-------•-------•-----------•--- Address- _G? --------- --- --- >---•------~` Ph •------------ - - - -------•------•-- - one..---------••---•----- Contractor's Name-- - - Other { -sf� artment House ❑ Commercial E3Trailer Court [3Motel ❑ Installation will serve: Residence � p �f --------------- "----._ Number of living units: ---I--- Number of bedrooms _. -- Number of baths --I. -- Lot size ------ 1�0ft. , Water Supply: Public system11 Community system El Private ❑ Depth to Water Table Adobe � Hardpan F]Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam ❑ Clay ❑ No [;J,hcation Made: (if New Construction: Yes [9--N-o ❑ FHA/VA: ❑Yes Previous App yes,date---------------- ---� No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_-_ ___---Distance from�oundatio q,id depth - Ca acit ��-�- jl LTJ No, of compartment'..IL- ------.Size Ligwd depth P Y I Disposal Field: Distance from nearest well---_.�'^. ------.Distance from foundation--L0------------ Distance to nearest lot line---�_--- --Len Length of each line--- Q ---------------Width of trench_-�___y--..------------------- ��' Number of Vines----- --------------- --- -- 9 - Total length-."-----� -:�----------------------I Type of filter material- le_P_L_A---Depth of filter matefia s :Seepage Pit: i}istance to nearest well-- ^-----,Distance from foundation_--_-1s .__�---Distance to nearest lot line�J-- "� Number of pits_--.--f--------------Lining material-5;!�P__-G�.Size: Diam --- ' Cesspool: Distance from nearest well_--_--.---.-_-_Distance from foundation -"----------------Liquid Capacity---_-------------------•---gals,—•, i ❑ Size: Diameter--------------------------- Depth-.- Distance from nearest building. - ---------------" -------- ------- ----------- Distance - -- - Privy: Distance from nearest well_________________________ - - ❑ Qistance to nearest lot line__--_------------------ ------- ---- -- --------------------- �! --- -- ---- Remodeli Band/or rep (describe) " '� --- -- --- " lam'+-_/�r�`-��-�•. --- - --`�"-=`--- -- -- -- - ------------------------------------------------ ------------ -------------------------------------------------- ---------------------------------------------------------------------------- - " 1 hereby certify that I have re ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru and tgationio /the San oaquin Local Health District. Sined ---- -- -------- --- ----- ----------------- - ------(Owner and/or Contractor( g �--- ------- ----------------- -------------`----- ,. - (Title)------ ------ ------ -- ----- - -------------- -- -- BY - - --------------------------------------------------- location of system in relation to wells, buildings, etc., can be place on rev 11 (Plot plan, showing erse si e . size of lot, FOR DEPAIt r MENT USE ONLY APPLICATION ACCEPTED BY----------------- --- DATE------ ---- --------------------- ` .eta REVIEWED BY ------------------------------------------ ------ -------------- BUILDINGPERMIT ISSUED---------------------------- --------------------------------------- --------- DAT ----- "-------- --------- ------ ------------ ------- ------ i " Alterations and/or recommendations:__---------------- -------- ----------- ----- --------------------- '1 -.--..----• 5 --•---------------------------------------------_.-..---- -------"- ---..-. �/ ------------- - ----------------- -------- --- ------------------------- FINAL INSPECTION BY:_--, ... . . Z- SA ---------- ---------- Date--- fJ ' ._ ------ -------- ------- QUIN LOCAL HEALTH DISTRICT e ` 124 Sycamore Street 205 West 9th Street �l 1601 E.Hazelton Ave. 300 West Oak Street I Lodi,California Manteca,California Tracy,California Stockton,California i II F.P.Cd.