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I FOR CFFICE4,USE: APPLICATION FOR SANITATION PERMIT Permit No. ....,f��5f --------- ---- --- -------------------------------------- I (Complete in Quplicatel Date Issued --- ------------------ ------------------------------ This Permit Expires 1 Year from Date issued Application is hereby made to the San Joaquin Local Healfh District for a permit to copstr ct nd install the work herein described. This,ap lication is made in compliance with County Ordinance No. 549. L�y�a `��( r[�� JOB 'ADDRESS AN LOCATION.. ��. Owner's Name----------- Q_FZ�_ _ 1 `� �---- --------------------------------------- -------------- Phone------------------------------------ Address--------- ------------------------------••---Address--------- -- _2 _-` 0--------_-�•-� K4 _1 ... ,��_ _L f _ ----------------------------------------- Contractor's Name----------0V11-t 4EK-----------_----- --------•------------------ ------ Phone------------------------f Installation will serve: Residence ®Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_.- Number of bedrooms?--_ Number of baths --L--- Lot size __ _-_._ .---- p ------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to.Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sand Loan Clay [ Loam Clay ❑ r ❑ Lir dobe Hardpan Previous Application Made: (If yes,date--------------------) No Jq_ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No R-'' TYPE OF INSTALLATION AND SPECIFICATIONS: I No-se tic tank--or-cess ool-. e, rmi+.M&-if -.ublic,seweris-available-wit hin-2-00 Septic Tank: Distance , t wel__--� - Distance f dation-f/eet0t)----- �M-a=f�eX-ri�a l. !gNC_� 4T1 ------- Noof,c�rn artme ts ; _------ �X�0�XY5___Liquid depth_..__ ----- _0.0--- 4)� Disposal Field, ..-+Distance from nearest well--.,5- ...-Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-------- -__ . � - ____--.Width of trench i-------_- --i-'--- ---- ---- --------Length of each line----___.-- !� -t --------i9v Type of filter ma'ferial"'� (�... _ De gth'=of'filler materlai+�J'_ Total length-__!.?_------ Seepage --__ ,-_ -. p g from foundation----, _'-,_-------D.istance to nearest lot line_.. 57-1- Number -.- I'r Num er of -ts!{. '��-------------Lining mafer�h O.G4�..Size: Diamefer_. _ ee a e Pit: Dis#ante to nearest we!_______. - Distance Cesspool: Distance from nearest well________..__-._ Distance fmaterial F } ` . 'I P De th----�,�.:-�--------,dafion---- --�� ------.Lining material--`---- ---------------------------- _ rom foun ❑ Size: Diamefer---l----------------------- ----- P ----------------------t-----..Liquid Capecity----------------------------gals. Privy: Distance from nearest well----------------------------------------------- nearest buildin ❑ Distance to newest lot line-- --- ------------------------------------- --------------------------•--------------- --------gj------T-------- ---------- --------- Remodeling and/or repairing (describe):----------------- ---------47777_77777__ 777-77 ---- -----------•--------------•---------- ----------------------------•---- ------------------------------------ ------ --------------- ---------------------------- - ----------- =' ---ti------------------------- ----------------------------------------------------------------------------•------------------- ' ---------------------------------- : - --------------- -.: =----------- I hereby certify that I have prepared this application and that the work will be done in accordens faith San"Jo q ih County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �� Si ned X'0-7 ;✓_� _ �--------------- =( g ) i _ ` r��y� :T .. (Own;r and/or Con+ractorl rt . ... _t- --- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), 1 FOR DEPARTMENT USE ONLY 41 APPLICATION ACCEPTED BY-- ---- ----- ----------------------------------------------------------- DATE-- -- - --- C -------------- -- r - ------ -------------------' ------------------------------------------ BUILDING,PERMIT ISSUED-----:---=---11.57 _ �_N 2�-_ - 4�---_ _-- --------.BATE-:------•----- ------------------ ----------------- - - -- Alterations'and recommendstions:.______.__._._ "'�"""" "�"" ---------------------------------- ---- -.. -1 °DTF -------- - --- ----------- ---- ---f ,,,, 't�- � ----------- --------------------------------------- ----------------------i-c�------------------------------ ---------------------------------------------------------i�----------------`--•------ -------------------- ------------------------------------------------ FINAL INSPECTIO - Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfockfan,California = Lodi, California Manteca,California Tracy,Caiiforniq F.P.C C. v +!