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APPLICATION FOR SANITATION PERMIT - Permit No. ..._G_/ (Compfate in Duplicate( Date Issued ...�.O/ 0+ 7 — 2-rev-07 a+ion is hereby made to the Sart Joaquin Local Health Disfricf fora permit to construct and install the work herein de: ' plication is made in egmpliance.w ith County Ordinance No. 549. , ri_1.349_0. 1 .. , 0 ,DDRESS AND LOCATION_....ri A 8f AIR _.ASa?0.RQ_�Q �..�"2.��M,��.fv!- t�� M•: sName....Willi=._�'_...-�I �2er:c- ......---------- ----------:... ..................................'.._. Phone------Lodi-9 1 s------------ A..-If.... o, -Calif.................... ctors Name_.._!aJ01'.i__W111.._AMP1P_ /.- Othez-s._t0-_do-_aO al:work.••._••••••• Phone................__.... ' tion will serve: Residence:] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1.... Number of bedrooms -...4. Number of baths ....9 Lot sae _l,8I1dX 802'68-_. -, ' Supply: Public system ❑ Community system ❑ Private M • Depth to Water Table .'69ft. for of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam® Clay Loam ❑ Clay❑ Adobe❑ Hare s Application Made: Yes ❑ No [j New Construction: Yes M No ❑ Addition to old constr )F INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T k: gg }D�istance from nearest well____Et _.._Distance from found .ation_. Q.._.......Material..._QQLISl3� •Q_... TYejen N. of compartments.__._-2.__.-...._. Size_.7'x1k'X5..........Liquid depth....._X4.1-------_.....Capacity _._.13 1�F,'yId: Distance from nearest well...a1FA....Distance from founda+iory.J.Q.._...7'Distance to nearest lot line._._ Number of lines......_..._2-------...__. L1of each line //_....... 0...Width of trench..._ 3...fts. 'tS61 Type of filter material.rOC�;.P.._✓Dbpih of filter maferial.12„.._t±9lrotal length__....................... le Pit: Distance to nearest well..._—_..........Distance from foundation..-.--'-----...Distance to nearest lot line__ Number of pits_....................Lining material.- ;_-__;�-.�..Size: Diameter._....._............-.Depth__.__......... Y ol: Distance from nearest well........-------Distance from foundation...................Lining material_.........-_--.-.---- . -;: :.•.a. .:Sizec,l7iameter•--„-:=-_:..•..ds:.:..ftDepth................ _ .1.iquid�Capac'ify . ' Distance from nearest well......._...................................Distance from nearest building................... Distanceto nearest lot line.---.._........................:_.----'.-•-----.-.-..-_---•---......................-...................... cling atld/or repairing (describe):_._Ne}�r_..construction consists,_----- f -additional_leaehin esent--lines are only about 07i long. In -add3:ti.o3i-connection of•'fine§ wasfi sub water ana:R” tcTien----- k:::water will-Be add'edas'-in33cated' to ... -- ------- -- ------- --- - - ing-_septic--_tank.-_New--_construction- n Gated on chart n n . ' lerebcertify that I have prepared this application and that the work wll be done in accordance with San Joaquin icas,lafe laws And rules and regulefions.of the San Joaquin Local Health District. � .. . r.. .... ... _ ----•--------------------------4R!M r nd/or Con -� .......t'4r, : ._ ` ... a tee BV:.......------------------------------------•------------__-------._......—...... .. -- —.....g....:............(Tif6)........-07JIleI'............................ an, showing She of lot, location of system in relation to wells, buildings, eta, can be laced on reverse side. FOR DEPARTMENT USE ONLY t :ATION ACCEPTED BY.... ... ...-_ —.-------- . —..... DATE -. ... -- -�� - e ✓ED BY-.._..---_--._..--._.._.-..._---_.-------__.-.._.--------_ __.... -----_--------—.._.__._ DATE__.............. VGPERMIT ISSUED---._----_-----.--.. -------_--._.--_....-------...._............................._... DATE..---._......--........_._:._........._.. ionsand/or recommendations:_.........-......_.............................._...-_-..._.....__......—...._......._—.__._ ._._......_........... ._............................-.--..............---...._..._._...._..........._..._...._.---...... .._......................................................._....-._.�...__-.-.--._.....-....-__.- �.._... .r..-.-.-. ---------- -----_--.------------- ._--------- _._---- ...-------- _..--------- --.... _............... .-.._..------------------- •-.------------._ . _...... —.._.... ._...._.................................... - --......-----.............----------•---------- ---•----- ------- 7—**---* D r1 INSPECTION” Date.....1A....V .... SAN - JOAQUIN LOCAL HEALTH DISTRICT ' South Ansedoan Streat 300 West Oak Street 132 Sycamore Street 814 North "C"Sheet Steekfoe, California Lodi, California Manteca, California Tracy, California -2M ; • Revised W-2100