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FOR OFFICE USE: ......................................................... APPLIGATION�fOR.SANITATION PERMIT Permit Nc. .(_�_7 34 . - - ---. ............ ........•- • ................ (Complete in Duplicate) Date Issued ........................ ..................... t This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct end i ereinjdescrld. This application is made in compliance with t County Ordinance No. Iel�o � / 4- ..JOB ADDRESS AND LO ATION_...- a+ ....130K u1 i.--.q0�4 Owner's Name.......;...-_-Ando Phone. �} ....................................................... ' Address----•-------..��_�._� �__O'�..----•---a��l�.�---.___.--------------••---•----..�:..._._..----•--__.._...---..... - Contractor s Name.............. .($. ... r_!!L:....----...�1�,D ---..._........._-----*....._-------. Phone...........____-----:...._... d Installation will serve: -Residence ❑ Apartment House ❑ Comma tal (�Trailar Court ❑ Motel �0 Other ❑ Number of living units: ........ Number of bedrooms ........ Number of baths ........ Lot,size ......... Water Supply: Public'system ❑ Community system ❑ PrivateDepth to Water Tablear.�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑ j Previous Application Made: (If yes,6te....................I No N ''0`New Construction: Yes ❑ No [] FHA/VA: Yes❑ No Lr�/ r • � ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p6 rmifted if pub/o,� sgwer is available within 200 fe't.) � Septic k: Disantefrom nearestw I.T(fjfy"isty duc mrfgu Ption.��.�fn..M +aria �..+.$� � �f.Nof;covmpartments..._ -CC.._.j._.�Siza. ;t� .JS-. .._LiquiddPpth..... . ...Capacity--_Zt.U-U.M. �r Disposal 'eld: /Distance:from n'earesfWe11..71B. Mistance from founds#ion.]A)A +,.Distance to neares ........line's N. line....... Width Type of fit4Vi tenial j ra {Depth of filter material.......- ..__.;...Total long+ ................�f�9.............. s •}. I Seepage Pit: Distance to nearest'well....'a..............tistAce from foundation._........._...._Distance to:nearest lot line................. S 171 Number of pits..- :.Lining material.=.................... Diameter..-...................:IDepth._t:..:..F.........I....... ._ &Cesspool: Distance from nearest well.-------..-,.`.'4Dlstance:4roiVfoundation......____..__._._Lining materiaL......Z;�.__N.: .._ ❑ Size: Diameter..-- ------- -------...........Depth.--- -- .---............................Liquid Capacify.:":, ...._`_ ..._.-gals. Privy:: Distance from nearest well............................��_':,...y�rMstance,from_nearest building_ .... [] Mifance to neares+lot line_._}._.............. _ .... ...... ITIf r' • Remodeling and/or repairing (describe):....jen. .. i...�_..�J! irl-!�•-..;t_� [llll- l-• ---•� i t: i ..._............................._..............._........_..—........_...._........................._..............................._.)...'i"91�_ ......... I hereby certify that have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State law and rules an reg lations of-the Sart Joaquin Local Health District. (Signed).... .. -_........... a..... ....... .-...... .... ._.......(Owner and/or-Contractor) G By—..-- ......:. ( ... --.....I. ;.:.-........... .... -..............---------{rflej. ----_----.------.-----------.._.•.............__._ 4 . .................• - .. t. relation t o. plea, showing sae of lot, location of system}n relation to cool&, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.............. ..'.__.'�:r .. � ...--- - - - -.. ATE.. � _Q.... ... ......... REVIEWED BY..._..... _._............!. �:�. } . - ----------...... DATE...., -- -- --. .........-------... . --------- _. - AJfera NG PERMIT. ISSUED---.......... -- -- - --T r� - DAT . —. .a ..� .Yc WBLF A{tera#ions and/or recommendations:........Ef�b'f+f...."7,G'A1.1!� �--•-,tial- . • •••• •••-•• .. _....i,... - _..................... � s s -� :: :::... . F. --- `-T� ....... -.. .' ...............................__..........._................---.._............---........:.............:.... ...:..... --------- _... .-- y .. . ... FINALINSPECTION BY:.... ............................................... ......... Date::,..-..:.x._......,.........,...,_..s-:_........ _..,............ r .r+✓f ,.t �l j7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasaiton Ave. + 300 West Oak Street 124 Syca are Servet 205 West 9th Street Stedtten,Califamia Lodi,California Manteca,callfemia Trary,California ES 9 REVISED a-59 3M 3.63 F.P.ED. '