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APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Date Issued --------7,1 rein Application is hereby made to the San"Joaquin Local Health District for a permit to can tructdns+ale wo�edes�cr - This application is made in.comphancelwith County Ordinance No. 549. JOB ADDRESS AND LOCAT ION_____ --l2i --•- 5 t a - Owner s Name:____ - /i "`; -n _ . on --------------- ------------------ Address-.--•----•--------•------- ------ ------------------------------ on V-�--- - o---- - Ph �� . --------- -`- - Contractor's Name______ Other ❑ t Installation will serve: Residence Apartment House ❑ Commercial ❑- Trail [I [3,Court Motel . Number of living units: . .____ Number of bedrooms _ ---Number of baths >I-mot size Dept to Water Table Water Supply:'"Public"system ❑ Community system Private ❑+ P Cla Loam Cla Adobe. ardpan ❑ Gravel Sand Loam ❑. Y ❑ Y ❑ Character of soil�to a depth of 3 feet: Sand ❑. ❑ y - No ,�, �^ Previous Application,Made: Yes El No W111,New Construction-. Yes No ElFHA/VA: Yes El4� TYPE OF INSTALLATION AND SPECIFICATIONS: +A (No septic tank or`cesspool permitted.if ubiic sewer is availablh with1n 200J.". t.) T . - e0 Disa_onc-e-b-Tram r-•o�-m----fondatiLon quid eP �� r C-apacity__-4.• --• -" Septic Tank: Distancefrom nearestd --- ,.No of'compartments_ J - Size. C�-Q- th ` l k er ti 1 �^ Distanc j -foundation_.--L._Q-°_._.Distance to nearest lot I'sne_____._ Disposal Field: �-r Distance from nearest well--' Len th of each line:____ -- -r______ _____.Width of trench__.6—*�- ----- ---- ` ':Number 'of lines-----1 ---b g _ � . Type of filter mafierial_! �'�e_ -- -Depth of filter material_-_� �/---Notal length_ � �-- le - r ..+.'� lcm -r - I Distancelfrorn fou%rdation_V 0_ f-- Distance to nearest lot line__. e to nearest wel/Q� ro y Number of_p;fs' f-- -1______Lining material__ �Gd ' :,.Size: Diame�e� --:- -De+pth s ------------------- At - -- - �[ .h Seepage Pit: D4stanc ------- -----•---- Cess ool: Distance from nearest wall:_:___,_____=i Dastancfrom foundation__- -- .Lining material___ __.'-____ _ p + ; "t; De th--------------------------------- Liuid Capacity gals Siie: Diameter-------- ----- --- #p ❑ _ � - � Distancefrom nearest building-1 �------------------------------- Privy: - -------------- --- ---- Distance from nearest well,_N '".` ----------------------- Privy: F -- ------- -- ---- --- - ------------------ _4e f ,... .z -�- --- = -- Distance to nearest lot line__ "�--------------- - I -,� a � ----.+--------------- ---- -----=--------------=------ ------•-------- 1 Remodeling and/or repairing (describe):_ ,y., =--------------- ----------•---- --- --------- . ______________________ ________________.____-_______-_____ 4__ 1 1 ------J__: = = „ ---------------------------------------------- i . 4 1 •------------------- - , --- ihereby certify that-I have prepared this.appkication and that +he,work will be done`in accnrd'ance with San Joaquin oun y ordinances, laws,-and'rules and regulations of the San Joan uin Local Health ict.,. Contractor) ,` = - `� ` �4RTMENT .� (Sign _' ed] ---------------------------------- -By:.--•--- o:..--•------ --- - ----( e] (Plot plan, showing size of lot, location of system in.relationbuildings;a , can be placed on reverse si e]. FOR DEP USE ONLY, _ DATE_-_ --- --- APPLICATION WED 13Y-ACCEPTED 8Y_-.: = - J -------- ---- -- DATE u REVIE ---------- ------=-- ------- DATE-_------ = -------- ------- - ---------- 1 -- --- BUILDING PERMIT ISSUED �- = r L -------------------------------------------- =-------•-------------- = .... Alterations and/or recommendations:_-'__----------=--- - �.,. 4 _____ . --------------- ------------ ..— _______________________Y—_ .......... �..., ---------•--- ------ -------------- -- --=--- ------- ---- .. - � - - Date---.�_-.f�-C�/_�----------------------------------------- -_ ,FINAL INSPECTION` BY:-_.--I-----=---- --.--------•- - - -- - --- - - - - � SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 13, South American Street Trac California Stoc£+o/n; California Lodi, California Manteca, California Y• ' Y r E5-9-2M , Revised 1.57 F.P.Co.