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-- " FOR OFFICE USE: Lf%' ............ ...... ... .. G Permit No. APPLICATION FOR SANITATION PERMIT o� (Compie#e in Dltplitate) This Permit Expires 1 Yeat_From Date Issued Date Application is hereby mode a_ 'he San Joaquin Local Heal+tl District `or a permit to construct and install the work herein desctif>ed. { This application is made in compliance f;tth�County Ordlnan,�e No. 549. C / JOB ADDRESS AND LOCATION.,. .�. � ?f..._.1F4.... �Y.FM•�I�- ....r'`f� �,_...O.L --... ./-.D:z :. Owner's rarre �•- r r . ............................_. ................................... Phone. . Addrltss...ar__. ....... ix.....I: .17 ....................._ .............__._........_..._.• --._..._...._.._.._. ... w Cor.rrecior's Namn__1Z" sr/Ys../.1/e.. ------•.......................... ................. Ins=enation wfll servo- Residence [A' Apath-iont "Iowa ❑ Crmmorcial ❑ Trailer Court [3Mo#ei [3 Other ❑ I . Number of living units. . Nu+nhi,r-ot i.r.dnx ms.X.. Number of baths........ Lot-size..... r Water Supply: Public system LA' C,,-r -%ni'y system 0 Priva'e ❑ Depth to W-ter Table....... f+ y Character of.soil to a depth of 3 feet Sand,J Grovel❑ Sandy Loam[ Clay Loam[ :lay❑ Adobe❑ Hardpan Q w: Previous Apai-cation Made: llf,yes,dote..............,...I No ❑ New Construction: Yes [R No ❑: FHA/VA.Yes❑ No❑ ;/ : TYPE"OF INSTALLATION AND SPECIFICATIONS: ` t (No sep+;c"fank or cesspool permitted if public sewer is available wifhin 200.feet.) d tet. . Septic.Tank: Distance from nearest well...4!Z .- .Distance from No. of compartments.... ..T'wc......S;Ye..._ZA.0...,P...........Liqu;d depth....t►L�."...••..�:Gepaufy ti'� y Disposal Field: Distance from nearest well...70!.....Distance from foundation.. y./'.........Distance to nearest,lot 3 O Num6er of lines:.....T/.VC7#V. O................ cf each line......//4.............Width-of trench._. .. Type of filter material.../,/I_...._....Depth of filter material -/__V! .:Tofal length Seepage Pit:. Distance to nearest well:.�.�`'fl..__...Distante from foundation../0..0` -.Distance to nearest.lot h�e t ❑" Number of pits...o'AV.�l.._..Lining material, '�/Yoc/�Size. Diameter....J� p � De fh S { CessFnol:' Distance from nearestwell................Distance from foundation...................Lining ❑ Size: Diameter... .............:................Depth...................-........- ...................Liquid Capacify gels` Privy: Distcnce from nearest well......................._--..___..............-..Distance frorn nearest budding ❑ Distance to nearest lot line................................ ......... ._... Remodeling and/os repairing (de cri,e;:.-. .,. _.* .-y _---------------- .7 n y -- __..:.....:...... ----.:.._..---•-•--•-----•------------------------...----•---------------------------:---•-••---..__._ :._:. _.:---:---:-- tt` l her certify +haf 1 have prepared this application and that the work will be done in accordancewlth San Joaqule'County 4. ordinance ate 14 , and and ulafions of file San Joaquin Local Health District. (Signed)..:. ........{7� 11- ... " _.. ......... :.... .-:........... . .:.. ...:.._... (Ownor end/or ContraCtorI".. .........-...............................•---.....--- Ifle).__:.. (Plat p an, showing size of lot, location of system in relation to wells, buildings, etc., can be placed"on reverse side) J _ . FOR DEPARTMENT USE ONLY !C� ;� APPLICATION ACCEPTED BY_.;.;.:�!.,...�_�rk- ....:.. ................ ..................................... D:ATE--��`..•.�'�r REVIEWEDBY.,..... ...........................• • ---•---- ................................ ... ..............._........ ^.tit _ : f?UlLDINC PERMIT ISSUED................................... 7� ......... )�TE Alterations and/or recommendations.._...a�. '`'C( ... ..p�S.-�. .•.r3-3. -•--- ....__._ 1 .._..-__.-• .: .. ...................... ....,.✓...... ..- ... ..._. ......._......_............................................_-•-.. .. 3 : .......................................... ...... _, ..._... . ............................................................. ..-'......... -.-"... ....... .. .... ..... .- .....""--_.. ................ _..............._ .. .( 6 i FINAL INSPECTION BY:� _ :e-...lDate... ............... . SAN JOAQUIN LOCAL HEALTH DISTR:Cr - 1601 E.Hai.tten J,,..- 300 Woo po!-51r..1 - 124 S camera Stm*1" 205 Wolf Veh S"".-: - Stptkren,Catil,r.nip - Lodi Celilprnia Menr.ca,ealirernia Tracy.Caluf n:o k E.M.97M 1.67 Vacgaard;'Ml- , S y r "