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APPLICATION FOR ,SANITATION PERMIT Permit No ...j � lr.
<br /> (Complete In Duplicate) r'.(a�y3
<br /> Date- *sued
<br /> V npp;icafion is hereby made to the Sen Joaquin Local Health District for a parmitao conitruct�and inifall the work heroin"described
<br /> • 7h s application is made in compliance with County Ordinance No. 549. - .
<br /> JOB ADDRESS AND LOCATION.. �j�„
<br /> W Owners Name........ LN.i�*'..1 .� .' .....'
<br /> t. Phony
<br /> ` Contractor's !Jame.. ,.rl..�.x.�..h.S,Y•.�1. .4...��-1rAddress
<br /> 6
<br /> one .....
<br /> Installation will serve: Residence Apartment Houle
<br /> Er ;.
<br /> ❑ P © Commol ciel,� Traily ..........rt. Motel•❑ Other,❑ tt
<br /> ti Number of living Lot size©.II.Q.,. .r l,'S"jJ x
<br /> f g units: ........ Number of bedrooms......:. Numbsr of baths 5 `r ti
<br /> x k ,
<br /> Water Supply: Public system ik Community system'l] Private ❑ Depth to Water Table
<br /> Character of soil to a depth of 3 feels Sand j{ Gravel[3 .Sandy Loam❑ Clay Loam Clay ��Adob + k�
<br /> " "` D ,. Y D a❑I Hardpan p, e
<br /> ' r a Previous Application Made:'Yes I] No ❑ ❑ No r
<br /> New Construction: Yas. No FHA/VAi Yes , n ,
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted If public iwer h availably within ZCp feN.) r r
<br /> I',•c Septic Tank• " - - - .
<br /> Distance from.nearest wall...
<br /> �istanc frq foundotion...(�!.„
<br /> NI err
<br /> No. of compar}monts.:.:y...,.....,::::S.ze.3 .. .':........Liquid depth-.' « a
<br /> L
<br /> i. Disposal Field: Distance from nearest-well.h.4—r,,�istance from foundation....JE
<br /> i .....Dis o rnfk est
<br /> "1 A. tarsce t ear lot to
<br /> Number'of lines.......... :.Length of each line......�.�l.. .......Wid of trench .•
<br /> i th
<br /> Type of filter material,
<br /> DePth`Offiltermaterial...:�.. -....Total
<br /> Seepage Pit: Distance to nearest well......... .Distance from foundation..'...'.......,.-.?.Distance
<br /> T Dt:tance tone
<br /> ❑ Number of pits......::. ...:Lining aterial...' Size: Diamotor ..
<br /> tot Ime
<br /> CessPool: :....: Dopth
<br /> P Distance from nearest well...:..........:..Distance from foundationmaterial.,.
<br /> in
<br /> © Size: Diameter........... .....
<br /> Depth =
<br /> 'n g
<br /> Liquid-Cap city.:.'.:"ty
<br /> r Privy: Distance from nearest well.., els.
<br /> •-•••• --•.......Distance from nearest building.,..-. 9
<br /> ❑ Distance to neatest lot line--• n
<br /> g r r+t
<br /> Remodeling.and/or repairing (describe):.........:.
<br /> 111 .-.•• -
<br /> ..................
<br /> ..............•-..........:..•.....•.,..-.,-,.,..._...__..,,.••,...............,..,..........w.• •.
<br /> F•�! -....•........................ - u'P
<br /> r, I hereb Certify that I haus prepared!his application and that the work will be done in aceordan" with San Joaqufn „
<br /> ordinances, Mate laws, and rules and regulations of the San Joaquin Local HeaNh District s
<br /> (Signed)..........:... i
<br /> r; By:......... i ......... (Owner and/or CoMraclor]
<br /> I ..... .. 4.
<br /> ...........................(Title}......
<br /> (Plot plan, showing sire of lot, location of sWam in relation to wets, buildings,etc., can be placed on revwrse side]. E :,,� 3•°.
<br /> IIIIII - FOR DEPARTMENT USE ONLY
<br /> } ----------------
<br /> APPLICATION ACCEPTED-BY................. .....
<br /> ....................... ..............:.:_,. DAT :.
<br /> REVIEWED BY.................................:........:: ....
<br /> ' 4
<br /> BUILDING PERMIT ISSUED.....
<br /> DAT .-
<br /> _.............:........................ DATE..........
<br /> r
<br /> Alterations and/or recommendations:........:..... -• •....` .... r----�•• 45
<br /> •. , Y ..... .. ....................•.......... -
<br /> ._ . .....
<br /> ............•..........._............_............................ -- -----—
<br /> w
<br /> F
<br /> INSPECTION BY:...,..
<br /> .... 41:7....
<br /> rs......... sate_
<br /> S
<br /> SAN JOAQUIN:LOCAL HEALTH DISTRICT
<br /> 110 youth An,eri<en Strost 300 Wirt Oak Streit- 132.syeamore streef-
<br /> Sloclfon, Cniifornfe E�14 Nor1k"C Strsel
<br /> Lodi, Celitornie
<br /> Manteca. calwarvTs. Trey;CeiiFarnT4
<br /> f•
<br /> ' - T1 • 4 ,
<br /> I
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