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ti r rrll--- u —, - R ------- - APPLICATION FOR SANITATION PERMIT Permit No. -. ..-.- -�_. � ------------------ ------------------------- --- ---- (Complete in Duplicate) Date Issued _3z_ — ----------------�--- This Permit Expires 1 Year From Date Issued - Application ishereb made to the San Joaquin Local Health District for a permit to co&,Irucans#alt+he work herein described. This applicatinis"made in compliant with County Ordinance o. 549. /� � ' pJOB ADDRESSeAND LOCATION = -- �, ...................................... .. Owner's Name .._._ y ----------•--- P e ..-.2...7.SL�Q_ 1 - - h �. ._. J on Address._... •... _-�--_--• .. r,,.,,. Contractor's Name... f a .. Phone- -•----•---•----- Installation will serve: Residences Apartment House [:] Commercial ElTrailerK.Court ❑ Motel ❑ Other ❑ E Number of living units: ___L Number of bedrooms ._:3_.--Number of baths � ` �-.. Lot size ..__�.�:?S...I'_"�.�--•--•-•-----•-------•---•=-- I Water supply: Public system R--c—ommunity system ❑ Private ❑ Depth to Water Tobls.�I ft. Charmer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ Y ❑ y❑ Adobe hardpan ❑ Previous Application Made: (If yes,date---- No 0' New Construction: Yes r. ❑ f No ❑ FHA/VA: Yes ❑ No TYPE ,OF INSTA. LLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dista ice from nearest well___�Distances from foundation__-_. 1�'..-•__--.Material_. _._..91 "P_. .. .. ... all No. of compartments----._age."--"___-_._ Size"-_9; ,�t: 'y�•"___-Liquid depth - - ----------------- Disposal -Cap. etY--SIJ w I p�'al l=field: Distance from nearest well:.•. ':"Distance. from Fundatio ___A_ __ -___-Distance to nearest lot line..._'.__..... i s os Number of lines------------ - ,_ Length of a lin Es',V idth of trench------.a2- "•---•----_- Type of filter material._. ' f/ „” ................... Seeps a Pit: Distant neare "" `�^ -- Distance from fo nce to nearest l umber o p1 s Line a e - iametery.. __ i ". 4................... Cesspool: Distance from nearest well_________________Distance from foundation__-._____.___�_l".Lining material a1 ___..___....._ _.._.___. ___ ._ ❑r Size: Diameter =Depth _— — Liquid Capacity_ :-:go Privy- llr Distance from nearest we -__".__ "_--__".-""________________________"--Distance frorn nearest building rice .......' ❑' Dis#ato nearest lot line.__..."�_ ________ •" • Remodeling and/or repairing (describe):---------'-------- -----=- ---_ I ''+ h -- "---_""-"r..--------------------------.__f ....__._._. ___________________`s-:.. -_�.11�` __._. `_'"_ _.__--_"_ . . ,� - r- ---- ---- -- - -----------• - = = ti- Ithereby certify that I have prepared this application and that the work will be done On-accordance with San Joaquin County ordinances, State laws, and rules and regulation of the San`Joaquin Local Health-District. ' (Signed) T ------- �- r-----------(Owner and/or Contractor By. - ------ ------------------ '° {Title ...._- -- ..... ...-y - (Plot plan, showing size of ` lot, location of system in gelation to wells, buildings, etc. can be placed on reverse side]:', � i i = APPLICATION ACCEPTED , REVIEWED By - _.lra::.2 - •-•----------- -------------•-------------------•------------------------- ------rpt-- DATE ,_. { BUILDING PERMIT ISSUED ---------- -----------•------------------ DATI=�`." -----••------ ...._ AI'terat"sons and/or recommendations:. "-_..__. _ . ..----•----•--•------•----....-•-----•-•--- -- { ------- ----------------------------------------- t 1 -.-.-.--••---••---•---------------------------•----------------•-----•-•--- r Y _______________________^___....______.____._..______.________...___.._._....._ FINAL INSPECTION B ----- _- '_ Date' --- SAN JOAQUIN LOCAL HEALTH DISTRICT:, 130 South American Street 300'IMsiji1dak street a24.Sycainore Sheet- '' rk .r ! 205 West 9th Street Sloeklan, -N-4Californla Lodi;California Manteca,California i �'�''T��./ w � Tracy,California EB 9 REVISED g-89 2M 5-61 Ail-AS