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OFFICE USE! <br /> Permit No. ...A.Z.`iL d( <br /> =....._:._ <br /> o sv APPLICATION FOR SANITATION PERMIT <br /> ---- ----- ..r.:..::................ <br /> (Complete in Duplicate) Date Issued .p_.�.._._._. f <br /> .-....... This Permit Expires 7 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permi+to construct and install the work herein describe ; <br /> ( This application is mode in compliance with County Ordinance No. 549. <br /> .._.... <br /> JOB ADDRESS LOC TION.. '--/�12 '" -�" QQ - <br /> }'� .-�--f . <br /> -._-..-..._� -- -- _...... ..............---..... <br /> .. <br /> It? Phone._.. .......... <br /> /car/r�Cry� <br /> Owner's Name.._... -,I <br /> I <br /> Address.. <br /> _ -- <br /> .. <br /> - <br /> Contrac+ors meld... . - - <br /> 1 Installation will serve: Residence M-'Apartment House [3 Commercial ❑ Trailer Court Motelli <br /> Ir <br /> Other <br /> Number of living units: .. Number of bedrooms Number of be s ..7--Lot size ._... <br /> M Water Supply: Public system ElCommunity system E3private epth to Water Table <br /> Character of sail to a depth of 3 feet: Send Q Gravel Q Sandy Loam❑ Clay Loam Q Cay❑ Adobe ardpen[I <br /> Previous Applicafion Made: (if yes,date..... ..............I No ❑ <br /> New Construction: Yes No ❑ FHA/VA:Yes Q No Q <br /> I TYPE/OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic tank or cesspool permitted if public wer is available within 200 feet.) r <br /> /Q . Material ^sc'"- <br /> Seaa�c Tank�� Distance from nearest well.-....:Distance from found ' �4ui 1-- pt - p •ty e M <br /> �6�9 No. of compartments...� ...... <br /> ... ize. pL.P �ul�iyyd��dap <br /> Distance from foundatio�.l.Y- •••Distance to nearest lot li�...�.-._. <br /> Disposal Field: Distance from neare ^ell,�d..... <br /> Length of each line <br /> Number of lines.. g ....IES??. .-Width of trench-aZ. ...............-. <br /> }� - <br /> 1 T\ Type of filter material Depth of filter material.._���.---- Total length...�, ln,-.---•--•---•••---- t( <br /> of <br /> istan e to nearest lot line. y �' <br /> f' <br /> Seepage Pit: Distance to nearest w ll_./P ._..Distance m f undation .. ' <br /> Fj( _ Linin material���.olG.�•_Size: Diameter._.�.�N---Depth..,....-�.._..---..�` <br /> Number of pih._..�....._. 9 <br /> 1 <br /> Cesspool: Distance from nearest well.................Distence fro rsrToundation------,.....y.....Lining material---------------------._.-----els. W <br /> Q Size: Diameter............................'..-_:...Depth-----------................................ ...Li?{uid.Capacity <br /> -:--._...---____._...9 <br /> Privy: Distance from nearest well....................................'........_.....Distance from nearest building........................................ <br /> .._............_.......... --- -- --- <br /> I ❑ Distance to nearest lot line...................... ---...........-...........----'---' i <br /> I Remodeling and/orre alrl escribe .-..-.•--- ------- y -:_.__._... _.....-.. ... _._- .N. <br /> .._..........................................................................._.._..,. J <br /> Y......._............................_......_...._....._. ...--....................-_................................._................---........._.............�------------------------- <br /> by! <br /> -------------------._.- <br /> 1 here ce that I have prepared this application and that the work will be done in accordance with San Jeaquin.Cnunty <br /> i ordinances, 5 la s, an rules and re ulations of a San Joa um I cel f tealth District. <br /> pp q \1N�. <br /> (Signed)_-------- - --_...................... .. •---•--. •.. <br /> t:. ..... X1.4 ...1._.... - t ....__..._.....--------------- tractor) <br /> ey:_....... — .... . - _ ---- ---------- sle).................................... ....... ................. <br /> I - - - - ._. ..... <br /> (Plot plan, showing size of lot, location of system in rale to wells, buildings, c., can be placed on reverses e <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- fes.-------- '----- ---- t <br /> - ' <br /> ...----.......... DATE. _. '4 ........- - . <br /> REVIEWEDBy.....-_------................................................... ...................--..........._.........-......... DATE---•---------------.-.-------------- ----•-•---. <br /> BUILDING PERMIT ISSUED........ <br /> •-- ....._.....-.....................--•--- DATE...-_---------------------••-••--------- <br /> Alterations end/or recommend..... ...... . ­40 --- <br /> .............--------...... .......... .... <br /> ......................._..............-......... ...... .............................................................' Det .W.....r............. <br /> - <br /> FINAL INSPECTION BY:. . . _._..._ d' -._..................----------_-..- <br /> �,, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.IbtalMs,Ave. 300 West oak Street 124 sysam9re Street 205 West 9+h Street <br /> sredee,,,califernie Lodi, California MGM..,callfornla Trary,Callfernia <br /> r.P.Co. <br />