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FOA CNLVE..USE: V t" --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------- --------------- (Complete in Duplicate) 4. - This Permit Expires 1 Year From Date Issued Date Issued �� Application is hereby made to the San Joaquin Local Health District for a permit to construct and instafl the work herein described. This application is made in compliance with CCQUn y Ordinance No. 549. CATION JOB ADDRESS A D LOCATION----------oTT�fl�.�- • --------t�-------�f�-------�0-=---•--��}'��`I�Q(�_.-------L1 --------------- OwnerOwner's 's Name----------AkNP s�Y� 1�i. Phone___----.-,-,-------------- _. 4 Address---------------•-RT--------•--3----------B-!QX------- C ------ Contractor's Name Phone.0----3_-"7._2/- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- --- Number of bedrooms,.._- Number o. baths _-�_ L-ot size ------/--a----A-CR S-- ____---_ Water Supply. Public system ❑ Community system ❑ Private tr"Depfh to':Wafer Table ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ ` Previous Application Made: (If yes,date.............` t, New Construction: Yes El'No EJFHA/VA: Yes El'No E]TYPE OF INSTALLATION AND SPECIFICATIONS: -..=;.=(No-septicTtank-or-cesspool-permitted-•,i#_peblic-sewer-is ava3a61e-within-2004ee+:) SepticTank: Distance from nearestwell___1�_--____Distance from"founn ation.--f ____j.Mate'rial-CC7NC_R a I No. of compartments-------�----------Size--- 1QX7._--Liquid depth!----- ----------- --Capacity- - -- Disposal Field: Distance from nearest well----,51? from foundation__- - __. f ��____�.Distance to nearest�ot line______ _______ t " Number of lines_____.__---______-__Length of each line_�?4_"!-~_�-V�.Width of treneh)----__-_�6- ----------- -f Type of filter material_-- Depth of filter material____._ __-- T.- -_Totallength---- _ � Seepage Pit: Distance to nearest well______________________Distance from foundation_.: Distance to nearest lot line----.' TR.0 ❑ Number of++pits----- --------------Lining material-------------- Size' Diameter( -, ;M.D,' h i Cesspool: Distance from,nearest`well """`Distanc feo�m foundation---_._-_-.-_-- _.Lining material!__ ____ --.-_____----_-. 5 _ ------ ❑ Size: Diameter....... Depfih---------- � - - - - - - ��-Liquid Capacity---------=---------- - --gals. ---- ----- - - --- -- -- -- Privy: Distance from nearest well______________________________._..-__� Distance,from nearest building____ _ ----------------------_- - ❑ Distance to nearest lot lineit 0 ---------- --------------- ------------------------- Remodeling and/or repairing (describe):------------------------ r------------------------------------------------------------------- -- ---------- _ ---------------- ------ -------------------------------------------------------------------- '"I -------------------------------------------------- -------------------- ------- t . I hereby certify that I have prepar"ed„this,application and,that.-the,wor.k:w.illtbe done=in-accordance3wi4&n�Joaq um ,Count ordinances, State laws, and rules and,reguia+ions of the,San Joaquin=Local Health-District. �...<. J. (Sign ed} ,f�-r`-- -------------------(Owner and%o Contractor) By:-----------------------------------=--------•-----------------------�-----;. -------------------------------------------------(Title ----- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings;etc:, can be 0IacEd on reverse de!: ` ` " 9 FOR DEPARTMENT USE ONLY" APPLICATION ACCEPTED BY `�---- ~---- ---------------------F---- -------- - � DATE REVIEWED BY-------------------------------- ------------------------------ ------------------------------------------------------- DATE---•--------•----------= BUILDING PERMIT ISSUED--�i------------------------------------------------------—------------------------------------ DATE f ------------------------------- -- Alterations and/fir recornrme ations:_------- _- �� -------------------•- --------- ----- ----------------- ''-__3L - ----- ----R R �r ,Y—=--------7-_s-R,-a------------------------------------- -------------------------------------------------------- -------------- .� ..-...-------------- i .'S '" ' i Www I ____________________________________ -.. : ._---- -.-__-_.__..... .___. _ ___._....___._.._____._...._.___....-____._.._._____....____ ..- - - -- - - --------------------------- ----------------- - FINAL INSPECTI w, ! � Date__. AYr�C_11 I✓D SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeh Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street n,Callfarnia Lodi,California Manteca,California Tracy,California