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FOR OFFICE USE: ' ..............................----.-...-.-..---..- -. _--_-- APPLICATION FOR SANITATION PERMIT Permit No. .f L 7 --------.--- .............. .... (Complete in Duplicate) /(r - - r — Date Issued ....�-f..- . . ..--...._......- _ . .............'......�..--- k This Permit Expires 1 Year From Date issued t Application is hereby made,to the San+Joaquin Local}fealfh District for a permit to cohstruct and install the work her ' descrbed., This appylication is made my ompliance with County Ordinance S49. JO ADDRESS AND C ON Q�e, ¢,!%'�o4t .nr- Q.--.--Qw— _----.- _ J Owner's Name--- .. ......-. .:' �:.----'--af----.;-...- -- -- - - - - --•`- ----_..--.---._ y Addiess_-------------qG--.f -` --�.`-- --- ---..-. - --- — r Contractor's Name.. • • - z7 A .... Phone......................— — Installation will serve: Resio1ance �A arime House ❑ Commercial ❑ Trailer:Court ❑ MMoo/tell ❑ Other ❑ ' Number of living units: ---i::- Number of bedrooms ___ Number baths - Lot size -__.-: . i... Water Supply: Public'systbm ❑. Coen unity system ❑ ivatto Depth t ater Table -------=ft. Character of soil to a,depfh.of 3 feel:+Sand-❑— r el G ❑J_ S y Loem Glay mo/CIO ❑ Adobe❑ Hardpen ❑: i "' —C'J/ Previous Application Made:. IIf yes,date-_ IO ............. .I�jN r New Construction: Yes No ❑ FHA/VA: Yes No TYPE.OF INSTALLATION AND SPECIFICATIONS: f `t` ; �>:� _ (No septic tank or cesspool permitted If public sewer Is available-wif iln 200-140 �Septic�lgrik� Distance from nearest well--------._. Disten {kPm fou`da 'or�----1 P�.----..Mater L..... -7�.- ..�....+ . No. of compartments---_. .- Siza_ ....-Xj.A.,r Liquid depth...._-�................Capacity....A= .de F �'..--.. l / Dispos ie Distance from nearest gl..-.-li0....Distance from foundation-_--ZO..:_-...Distance to nearest lot i Number of lines_._..- _. LAgth of each line...... ..._. Width of french._-.3, Type of filter meteriet._ _----_' s r yp -4 Depthlof filter material_-_.- - __T_ . Total length.. - .�._...._--_.--_..- pQ Seepage Pit: Distance to nearest well.- �:.--- v:DlYtance..4m foundation.__-:--_.--_--.Distance,to nearest lot line-----_.-------_ �:•� ❑ Numbe'r of pits.....................1Lining materiall-.--_Aa)....... . Size: Diameferr------------...........Depth--- ------.-------� ( ' Cesspool: Distance from nearest well..."'--�.'--,.tr..Di fence from foundation...--...___.!_Lining material_....._.:____------.:_-_.._`��( ❑ Size: Diameter............-••----'----......... De�p�,tih,._-----------------------:------...Liquid Capacity...........---...........gals. T ' Privy: Distance from near°est well..._...-_-...-:...)__-.t..:.z._�-'\.Distance�fr:om.nearesf building_-_.....__.._--.-_.._. ....... / ❑ Distance to nearest lot line----___---__.-__.� _--.-a.. .. .........__.-_.__._._----.-._.__.-.._---.____---_--_-_._--___---_.. _-_ n Remodeling and/or repairing (describe) ...... _, ---------- U .............. "r �. -----------------_---------_..... t I .. .__-_-•--__....._-...-__... ...-_-- -._ _...__-__.......... _...... ---•--_-._.....---__..-_..---_..-...--•_--------------_..---...._..... --- -•--• •-•_-• I hereby certify that Phave prepared this application and that the ''work will be done in accordance with San Joaquin County ordinances, State law Lanrulesand regulationsof,theSan_Joaquin Lccal Health District. Si ned ._.-- _.-.._._.-._�-----•-----....-.. dor Contractorl g )---------------- -------- : - _ --me n / ) -- �. :-:+—.ter-� �s r: 1 r __r .: - By:__.... - r -�-----• ----- �rt4)•------....... .......... .. ............. ..... (Plot Plan, showing size of let,.location of system in relation fd0lvelis.buildings, ate., ean.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_- -_—...._................._..._.__............ DATE.._Y 7! -f.:4-11' ........................ REVIEWEDBY...................%............... ......... _.................................................----...-..........-- DATE.........................................------ ..... BUILDING PERMIT ISSUED_-----------------------------------------------------------'--•----------------•------------ DATE.......................... Alterations and/or recommandations:.. ....................-............................ —.-•----_.._...__......-....................---..................................... -........---- -------------------_._...p_-.....-......._-:-....- ................ --............•--_-............_..-. ----------------------------_....----------------------------------- ..........................................._.r_....................--..._.__............ _.................---------:-------------_—............................................ .:._............. .......---_.........................-----....__....-..--•----'---......-----...................-..----.......--..........-.._.._.-----------______-_/.._ _...._.....---.......................... ...... FINAL INSPECTION BY• - Afsg. ............ .. -60 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 r.Headlam Aw: 300 West Oak SMN 12!Sycamore Street 205 Weil 9m Street $lade n,eallfernie Lodi,California Manteca,Colifornlo Tracy,California is 9 PCVI5E9 B-SV ]M ] '63 i.P,Ca.