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OFFICE. USE:. ,.�;�� / g �10 5 ---- :.a_�.Q APPLICATION FOR SANITATION PERMITPermit No �----- ------- ----- __ __ ______ _ (Complete in Duptate) Da+e Issued ____.__- This Permit Expires 1 Year From Date Issued A lication�i - . a -- s•,hereby made:�o the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicat is made in'c pliance with Couri�ty_�Ord�ance No. 549. //► �/�jC�� / - - ----- ------------------------- JOB ADDRESS AND L CATION------- ---- �/U ^ h ��' l!lf� //�� Phone_ �✓ ' P.� % �- / f Owner s Name______ - � - ----------------------------- �- ------- Address--------- •-------• one ------------ ` - -------------- ----------- Ph ...................r �Name------------ --- ------------ •-----•--•-------- -�----- Installation will serve: Reside6ce ApartmentfHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ��- ----- Number of living units: -.----- Number of bedrooms _- Number of baths Z--- Lot size __.. "- a Water Supply'; Public system ❑ Community Sys, ❑ private [L•}�pth to Water Table __ r�-- ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Cla Adobe 0 Hardpan ❑ Made:" If es,date- ._.} No Z--'New Construction: Yes o ❑ FHA/VA: Yes lam' 'moo ❑ Previous Application Mad # ( y TYPE OF INSTALLATION-AND_SP_ECIFICATIO.NS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well_- /"----Dist n e from foundation__.__/O_- ---.Material_ -�-� f / ?� - Ca acct Si y tl Liquid depth P Y No. oficompartments_.-��-_--- ------- - � �f`t�- - q � a.�_.__"-D'stance to nearest lot line_"-w�_------- Disposal Qistance,.from nearest well -----.-Distance Distance from foundation___ . ) I ru Len th of each line__ -,Ldp /°b�idth of trench_._.c�_�- Number of lines-------f-------------- ------ --- g 6J i - De th of filter material-_- _ -----.-Total length_. .-�--------------------- b Type of-filter material P Distance from foundation--------------------Distance to nearest lot line-_.-_.______".._- s Seepage Pit. � Distance--to;nearest well---------------------- G to i g Number of3pits----------------------Lining material-------- --------------Size: Diameter-----------------------Depth------------------ El Cesspool: Distance from nearest well------------ Distance from foundation__________________.Lining materia___.._._.--------- - gals. r l Depth ----- Liquid Capacity_-= v--------- I Pri ❑ Size; Diameter-------- ---- ---------=-------- P --- Privy: Distance from nearest well-------------------- ------ ----------------- Distance from nearest building________.-------------------------- ❑ Distance to nearest of ane ------ ------------------ -- ----- ------- ------- ---------- i Remodeling and/or repairing (describe)---------------- --- -----T---V--------------------------------------------------------------------I--S-----------y4-----_--J--------�--------R--_--------k-------------------------------------------------------------------------------------- ---- .---- ---- ------------------------------------- - - ------------- --------------I----------------------------- I I herebycertif that I have prepared this application and that the work will be done in accordance with San Joaquin County _ _ Y _- -- ordinances, 5t laws, and a'nd reguIa-jj ns-of the San Joaquin Local Heath District. ___ _______ ______________________________ _________{Owner and/or Contractor] �{_ - - ------------ s Signed l c.w..��,� ... . .. .. --- [ , {Title) Ii 4 [Plot plan, showing size of lot, ation of system in relatio - ells;-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Jz - efsCCEPTED BY --- - �.�-- ---- --------=----------- --------- ------ DATE--- /7_^--- ----- --------------------------------- APPLICATION A I DATE------------------------------------- ------------------ - REVIEWED BY----------------------------------------------------------- --- ----- DATE------------------------------------------------------------- BUILDING ---- ---- ----- -- BUILDING PERMIT ISSUED---------------------------------------------- Alterations and/or recommendations------------------------------------------------ ----- --•-- --------- - -------------------------- 77Z FINAL INSPECTION B _. ---- -- -- Date / --------- --.------ ! SAN JOAQUIN CAL HEALTH DISTRICT.., 205 West 91h Street '1 1601 E.Ha:ellon Ave. 300 West O'ak Street ) # '1024 Sycamore street, Lodi,California ►Vyanteca,California Tracy,California Stockton,California r.P.Co.