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APPLICATION FOR SANITATION PERMIT Permit No. AZZ J�_ <br /> I (Complete-iipFkate) Date Issued <br /> { This Permit Expires 1-Year From Data Issued <br /> Application is hereby mode to the San Joaquin Loc � <br /> Local Health District for a permit to construct and install the work herein described. <br /> This application is made*in complionc ,wi+h CountyOrdinance No. 549. �"-7 <br /> 2 q1 2-9 >E &+cw,q-Y <br /> JOB ADDRESS AND LOCATION. .. <br /> ......!w�. 7/_._�. -------------- '' `".�^'- -' ---------.�... <br /> s . ---------- <br /> Owner's Name_.......N/}-A�....�._..---_P�._y!2�4.�.............._..........................---`----.._---------'----------'------ -2: <br /> - Phone._ .._ ...,-.. <br /> Address_..l.91.z .5'..:, �trNn Cr/.eX....�2f ..... - � /�p�y -- "` ......_......_yY% -�`�`.............. p� <br /> Contractor's Neme_4i_makP.vff:.f&...f...9o.v......_....- ................ <br /> ------....---.-_--.....................:_....'---... - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living nits: I..._<Number of bedrooms I_ Number of baths A_ Lot size -.4W ......... --------------------.. <br /> Water Supply: Public s�stem ❑ Community system ❑ Private Er)'-Septh to Water Table ....._ it. <br /> =.1 <br /> Charac <br /> TYPE OF of soli o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam[Clay Loam 0 Clay [] Adobe❑ Hardpan ❑ (� <br /> _/ _./ e1 <br /> Previous Application Made: (if yes date....................1 No L7 New Construction: Yes L� No ❑ FHA/VA: Yes e% ❑ <br /> PP <br /> N AND SPECIFICATIONS: <br /> (No septic tank w cesspool permitted if public sewer is available within 200 feet.) /J <br /> Septic Distance from nearest well_S±...Distanc from foundation.--.��.__.._..Material&P-.S!t'' _.._-_..........-. <br /> L7Capacity /Zoll <br /> No.Pof compartments---------�[`...........Size....-.Y'L�:..............Llgwd depth-.--�.��.�...._ ...._.---.----'--' <br /> Disposal 'old: Distince from nearest wel6�_f._.._Distance from foundation..".�e..(.........Distance to nearest lot line..07 <br /> Number oflines_........_Z.....................Length of each line____._- ----._..Width of trenchi3.�<Z.._-,-..______.___----- <br /> I Type of filter Material...Q.ZO�!!�(.---.-....Depth of filter material.......$...............Total length..................................._.-.-. <br /> Seepage Pit: Distance to nearest well_-_��.��---.-DistanceiAom foundation..../46........... ,c(styance to nearest lot line.... <br /> Nurnber of pits---(_._-.._......Lining material.. oG�4.......Size: Diameter..&Y-1_.......---Depth....4p...................... <br /> Cesspool: Distance from nearest well.................Distance from foundation------- ----------Lining material...--------_------------------------ <br /> 1: <br /> t Size ! ------ - ---- -_...._...gals. <br /> ❑ Diameter----- ------- Deth - --------- ----- i uid Ca ecity....S ; <br /> ( I ..Distance from nearest building ' <br /> • Privy: Distance from'nearast well--�--------'----�--------'�-------------` -----------=-----------------'----...... <br /> ❑ Distance to nearest lot line-----...----.:........................................._--._......--..---..----..--_-----................_.....--.....:................ <br /> Remodeling and/or repairing (describe):-------------- ---------._............ ..........--------'----.-...-.._...-----.....--...-- ...............................---... e <br /> ( --'---:--'-------------------------a--...............................------------ ----___...---------------- ---------------------------""-------------------------_------.--...-- <br /> 1------------;;--------- t . . . <br /> ----------..__----...........----..........-...--- - <br /> -- <br /> -------.........- t <br /> I r <br /> - f <br /> I hereby -certify that I have pr-epared this application and that the work will be done in accordance with Sari Joaqui; County <br /> ordinances, State lows, and rules and regulations of the San Joaquin Local Health.District. <br /> -...........(Owner and/or Contractor) <br /> I (Signed) - <br /> - t � <br /> ..._.�ZCttcf.... - -------------- <br /> By: _....--.....------------ <br /> le) <br /> (Plot plan, showing size o lot, location of system in relation to Wells, <br /> , ere., can be plated on reverse side). <br /> t ' <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_------............_..._.....- ------------------------------------------------------ DATE_... <br /> . --' /p- --------------------_ <br /> REVIEWEDBY.............B- --..._......_-:.....---_.-----'.-..........-'.. ------- -----------�- .....................DATE........ ...... ..........+-----------------..... <br /> BUILDINGPERMIT ISSUED..........................----- -- ................................... DATE...........------.......-`-- - ------- <br /> Alterations and/or rec4mmendat'rons:---- -.......--.................... <br /> .....-.....-.....- <br /> c ..- ......... .......`_.---- - _..... <br /> ----------- ..... --- -- -------------------- -------------- <br /> ---° - -------------- ---: - ------------------------- <br /> --------------------------°---------- ---------......- -..._..-- -................ <br /> FINAL INSPECTION BY:...r4_ ._..---41'`50�-..Id Date._...!l---�. - -�../.---------- ---.....-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Narel?en Ave. f 300 Wes?Oak Street 120 Sycamore Street 205 weir 9th Street <br /> S?ockten,Calllemia <br /> .Lodi,CalifW-1a Menteca,Callrer.is T,ecv,California <br />