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APPLICATION FOR,SANITAT Rilk U _01 -Pro 'r 0 it No. (Complete , in Duplicate EXPIRES ONE YEAR FROM DATE Dat Issued Application is hereby made to the Son Joaquin Local Heal'th District f& M a permit to construct i"t, f h his application is made in compliance with County Ordinance. 0. 549.work herein described. JOB ADDRESS ANWCATION ------------- ----- --------------- ------------ - ------------------ Owner's Name --------------------- ---------- Phone Address------- --------------- ------ ----- II , _ ----------------------- -- -------- ---- --------------------------------------------------------------- Contractor's Name-------- -- i --------- -----------------------------L------------.0 -------------- ------------------------------------------------ Installation will serve: rResidence Apartment House E] co-m—merc—ialff—Trailerr Court E] Motel E]L Other E] Number of living units: Number of bedrooms _2e�_ Number of baths __/---- Lot -size ------1_,5� Water Supply: Publj,c1 � .1- - t ---------- system Community system E] Depth Depth to Wafer Table ft. Character of soil to a 11 1 1 epth of 3 feet: Sand [:] Gravel E] SAndy Loam E] Clay,Loam E] Clay El Adob Hardpan E] Previous Application Made: Yes E] No New Consfrucfiori: Yes )�;K_ No 0 FHA/VA: Yes E] N� TYPE OF INSTALLATION AND SPtCIFICATIONS: (No septic fanW or' cesspool permifted if public sewer is available within 200 feet.) Distance from , Septic Tank: nearest welll___L__Il� Distance from I I - Mate�W --- - -- --------- No. of comparfmenfs__,___,.r,.1 ----------- -- Sie_t4_` ui e ---------- Capacity_- u,ig'p"al Field. Distance from near+ weli I i Distance from founclatio, - - - ------- Distance to nearest lot lin!" ......... NJrnber of lines -------- - ----- Length of each line ------ -- - --------------Width of fren k' C ---------- Type of filter materia Depth of Cfer material:-*--- ...... .- tal length--_-_:_"" - 15Fe�7 ---------- Seepa e Pit: Distance to nea L rest wel�� 'rest lot line -- ---- Distance fFo f Z68 ion -------- stance to nearest Number of plfs-- ri ------------- ining mate 4LZ,�f --.Si e': Dia eter__' ------------- Depth Cesspool: Distance from nearest well ----------------- Distance from foundation --- ------- -------- Lining Liquid Capacity- material-, _001 00 Size: Diameter-- -----=------ ----- __ ------- ------Depth- ----------------------------- --: ----------------------------------- ------------------- apacify ---------------------------- gals. ivy: Distance from nearest well ------------------ Distance from nearest building I ----------------------------------------- 171 Distance to nearest lot line--------------------------------------------- -- Remodeling ire----------------------------------------------- Remodeling and/or repairing(ciescribej. I--- ..... --------------------------------------------------------------- ---------- ------------------------------------ ------------------------------ --------------------------------- r --- �--------------------- _ ---------------------------------------- --------------------------------------------------- --------- -------------------------- -------------------------------------- ------------------------ * --------- I ----------------------------------------------------------------------------- ---------- -------------------------------- --------- ------------ --------------------------------- % ------- --------------------- ------------------------------ : ---------------------------------------------------------- A ------------------------------------ I hereby certify that I ,have dp)reparecl this application and that the work will be done in accordance with San Joaquin County ordinances, Wb Ila j , 4 Te �ed rules and regulations of the San Joaquin Local Health District. (Signed]-- ----- - - ---- --- ntractor) /, 10 ---- . . .... Ize By '� --------------- ----- --------------------------------------- ----------------------------------- ------ ------------------------------------------------------ ----------- (Plot plan, s owin ize of lot, locatiokof system in relation to wells, buildings, etc., canT' b FOR DEPARTMENT USE ONLY '6N ACCEPTED BY ---- ---- I I APPLICATION -- ---------- - -------------- -- -- ---- ---------------------------•------------- DATE ------ REVIEWED', By- ------ ------------------ ------------------- ---- - - BUILDING PERMITISSUED-----------------]--- ---- - - ------- --- -- -- - -- ---------------------------- DATE__ --------- -- ----- --------- ------ ---------------- ---------------- DATE -------- ons -------------------------------------- Alferafi O/or recommendations: - - ------------- ---- ----- --- - ----- I -------- ---- --- - ------- - ------------------------------------------------------------------------------------------------------ ----------- I --- -------------------------------------- ------------------ ------------------------------- ------------ N ------------------------------------------------------- ------------------------------ ----------------------- ---------------- , ---------- I -------------------------- --- ----------------------------------------------- ------------------ --------------- --------------------------------------- --------------------------------------------------------------------------------- ------------ -------------------------------------------- - ----------------- FINAL INSPECTION BY:. ---- --------------- - ------------ -------------[)at Date-----= �1_ A T SA' JO kQUIN LOCAL HEALTH biS -A 0 eut ,Ain ricen Street 30D West Oak Streit Y,4, 132 Sca more, Sf reet • 814 waiih -!6--streot 'Sfo&N, California Lodi; Califo nia ,o 0. j �3 I� ES Revises � 57 t 1 F-PC0- )4, 4 —