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�` FOR OFFICE USE:✓ = IV_ l�6 GG-- ---- - --/�" -------- J x - 3�ad--_.-. APP�iCATION FOR SANITATION PERM1, Permit No. /-~,77:e.�- ------------------------ (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herei escribed. This application is made in compliance with County Ordina No. 549. zzt JOB ADDRESS AND L A ON--- t .-- -- ---- Owner's Na __-- - - ------------------ Address --------------- Contractor's Na -.- �q �--- `�� ---- ----I !!�--I f f Phone . ._ Installation will serve: Residence ❑.. Apartment House ❑ Commercial ❑ Trailer Court �v otel ❑ Other ❑ Number of living units: _�j�°___ Number of bedrooms -------- Number of baths -------- Lot size •- L.--------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ N. Previous Application Made: (If yes,date--------------------1 No ❑ New Construction: Yes ❑ NW)e—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: epf ..cNo septic fank.or cesspool permitted if public sewer is available within 200 feet) Ta _ Distan Barest wel _ L--_- -__.--..._Distance from foundation_ ________________.Material--_.______.__-_----__.---_-__._____--..____.._. o. of compartments ---------------_--Size--------------------------------Liquid depth--------- -- -- ---------Capacity---------- --- -- ----- I - sa Fi istance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------.---- TYPe of filter material___________ ___________Depth of filter material----------------------- length_.....__...____________.____-______-__. S*efage P Distance to nearest we ---------Distance from foundation_/L1 11-7 to nearest lot line_ _-.��%y P g Size: Diameter �. Depth-- ,, OS ,QQ( Number of its---_�________________Linin material-. . . _ Cess ool: Distance from nearest well____--_---__._-Distance from 0undation-------------__.. Lining material------------------------------------- 0 Size: Diameter----- -------------------- - -- ------Depth---------------------------------- -------- ------Liquid Capacity- --------------------------gals. LA Privy: Distance from nearest well----------------------------------------------____Distance from nearest building----------------------------- _________ ❑ Distance to nearest lot line ------- ------------- - ---------------------------------------------------------------------------------------- Remodeiing and/or repairing (describe):-------- ------- -- ------- ---------- ------------------- ----------------- ------------------------------------------------------------------------- --- ---- --------- -------- --- -- - ---- Z - --��-�----- -------------------------------------------------------• ------------------- ---------------- -------------------------------------------- •--------•---------------------------------------------------------------- -------------------------- ----------r---------------------•---------------•--------------------------------------------------------------------------------------------------------------•------------------ I hereby certify thatc4ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aadhsules and regulations of the San Joaquin Local Health District. (Signed)-------Sfo-TIC- T-AftK--SERV10E----- ---------------------------- -- ------- ------ --- --------------------------------------- - or Contractor) By:-- 2915 E.Miner Ave_, • HO.6.3841 [Title)--------------------------- - [Piot plan, showing size of lot, location of system in relation t wells, buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY /. APPLICATION ACCEPTED BY - -------------- DATE------ �� REVIEWEDBY-------------------------------------------- ------------------------ - ------------------------------------------ DATE �. BUILDINGPERMIT ISSUED---------------------- --------------- ---------- ------------------------------------------ -----. - •TE-------------------------------------------------------------------- Alf ati�s an /or recoynmendations:---J"1_-"......------ v 1 �l alt t_r �r�r�y ,-----�?, r� Cly !�. ------ - - --- --- -- ---------------------------------------------------- ts_!. ' -f--------- ----------•------------- --------------------- - ----------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------- ------------------------------ - -------------------------------------- ----------------------------- `qL INSPECTION BY:-.-., ------------------------------------ - Date----------- _71'x------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 01 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California ckton,California Manteca,California Tracy,California