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FOR OFFICE USE: r APPLICATION FOIL SANITATION PERMIT Permit No. .6��-S._ S (Complete,in Duplicate) p� +C This Permit Expires 1 Year From Date Issued Data Issued .�....�r . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. liThis application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOO�CATI N......//�, ..,.�..��i�CI.. .le .......... �40 r�.�. ., 1 Owner's Name.,,, i� S�r...... Q .�i.. � .....,. Phone........:::... ... .. G �ilfJ.. ..1 ........ � pss.+:�r ..... ......... , .......... .. ...................... . . . -.1 . .. Address.... .. . Contractor's Name...... ....... /.�p.•rla.....:/w07 .. . .. ... . ....... .......I............ ......... . Phone...... ................ Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: Number of bedrooms !3 . Number of baths .`1- Lot size . .... ..... .... Water Supply: Public system ❑ Community system ❑ Private R?0'fepth to Waier Table ag�Pil Character of soil to a depth of 3 feet• Sand C] Gravel E:1 Sandy Loam ❑ Clay Loam ❑ 0ay ❑ Adobe �Har� C]pan Previous Application Made: (If yes,date. I No 93" New Construction: Yes ke--Nc ❑ FHA/VA: Yes Z�r No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.l i00 Septic Tank: Distance from nearest weal. xo"e. Distance from foundation.. 'la ... Ma/re jala/"L. [l}r tie. of compartments _02. .... S;ze3 .6 Liau:d depth.f�. _ n1 Disposal Field: Distance from nearest well ". . .Dis.nnce fromfoundation. ,tz. ........ . Distance to nearest lot line..lt�..... ..... . [1}� -lumber of lines .l. ..a2 Lengtn of each line.. ..>4r. ....... ....Width of trencn.a.". ..., .... Type of filter maieria'../ f/09PW Depth of inter mater'al f�f� .. .Ictal length../�`Q Seepage Pit: Distance to nearest we•'l../460, d /. Distance from fou dation �p_..... Distance to nearest lot line..bf`..... .. 9 " Number of p,is...�.,., Lining material /�� Size: Diameter .�. .. Deptn.o2x_'.AW.-..ek/ . I Cesspool: D;stance from nearest well ... .. .... Distance from foundation... Lining materia! . .. . .. . . ... ............. I 171 Sze: Diameter. Der tn.. ... Liquid Capacity. . . ..... . ... ........gals. Privy: Dis'ance from nearest well . Distance iron- nearest building ❑ Distance to nearest lot I;ne ... .. .... ... .. . . . ................ ....... .............. .I......... . .... ...... . ...L. .... ..... ......................... ......... .. �! Remodeling and/or repairing Idcscr oe): iZlrll .. T.`G.. ,.S r .. . fj7... - . ............... r- ... ."...... .... ..... ........ . .. ...... ...... . . .... . . ... .. ..... -..I....._....... ..... ...... ......... .... . ... ......... .. .... _. .... . . .... ...... hereby certify that i have prepared this application and that the work will be done in acc,; dance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed). ...... ... QIU.. L�Q �' .. ... (OW11,110MMAgor Contractor) i By:...................... .. ...... ... ...... ... . ... . .. ..... (Plot plan, showing size of lot, location of syste to relation to wells, buildings, etc., can be placed on reverse side). — FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y.W- �� .... ... DATEJ/7.l.�.G.�.. ....... ... �. REVIEWEDBY.. . ....... ... .. . .. . ... .. _... _... _ ...... ..... DATE. . . .... .. ........ ...... ...................... . BUILDING PERMIT ISSUED........ . . .... ... .. ... . . ..... . . ... ...... DATE .. Alterations and/or recommendations:.. . . ........ ...... .... . ...... ......... ... ... .......... ... ............ ........... ...... ... . i FINAL INSPECTION BY:...... .� Date. SAN JOAQUIN L CAL HEALTH DISTRICT 1601 i.Ifaielten Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Slecktan,Calitosnla Lodi CoMamia thanteca,California Tracy.California E w 9 2M 1.67 Vonguord Prost