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FOR OFFICE USE: � - � yAPPLICATION' FOR SANITATION PERMIT Permit No. .s? ... .........................................:-----•-- _„----_„-.-:-.•, ._,,,•.- (Complete in Duplicate) Date Issued ..-•-_-_--.•-•--_. .....................................•..._......_.. This Permit Expires 1 Year From Date Issued Applicaion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordine 549• JOB ADDRESS AND --- /ND LOCATIO - --- -- -- - - - -..-... . .-. .. .- .---- ---........................ .---- Owner's Neme...�_L�r.F_ .......... .. .X�. +1�-.��_G./._4r_.jo4.pI-----------............................. ..... '--........------- -- Address---......... 0..0....-�Yl_t. Contractor's Name.---.......PA.. _-1.14if----'-----*f--'--.S.8��...�... ..v�-t---'.................._.... Phone.¢�0..�?..�b.�.�--... Installation will serve: Residence ❑ Apartment House ❑ Commercial 51 Trailer Court ❑ Motel ❑ Other ®*040114/- i Number of living units: -------- Number of bedrooms .i._-. Number of baths _...._. Lot size .__Cl... -—:-+t=--.----- -+------- f $.Zr._. Water Supply: Public system ❑ Community system El Private Depth to Water Table it. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes ❑ No FNA/VA: Yes ❑ No [a' j” TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' i 1 0 SepticTenk: :'-Distance from nearest wall/41W..,-�.._.Distencerfroiri founde+ion../.Q_._......._.Mefe,ial.__ _.. ..._..._..... ___.........__ X No. of compartments..2k_......- ..Size..3t ...........-.-Liquid depth..'5 .......--- p fy,. .ZOO 0 t. Disposal Eield: Distance from nearest weIL./S�._...Distance from foundefion..?-0.-..-.._Distance to nearest lot �f Number of lines-AM. - Length of each line. Width of trench....'i'.4_!i_-_-....__-.... g !i'--' d Type of filter material,. _ _.....Depth'of filter mate nal...Ld...__.... .Total length..._..�SZ�................._..... Seepage Pit- Distance to nearest well....-Sr..........Distant. rom undativn..�0.0_..--Distance to nearest lot line..Z0_-. Number of pits_.y-----------Lining materiel. .....Size: _......-.....__ Cesspool: Distance from nearest wel---------------Distance from foundation....................Lining material........._-_____�....__..---._. . ❑ Size: Diameter..........__............. ....Depth ...................._............. . ....Liquid Capacity.........._..___---gals. Privy: Distance from nearest well._.,-..---_.._.-----..................A-_-Distance from nearest building.............__.--_.._—.—---- Distance . - Distance to nearest lot line.... ------------------_.._--._.. -- -•---___.__.._---•---_.....—._......--' 11 RerJgodeling and/or repairing (describe):-. - I-'� . ._-. .�..e,_.--.. �rl�-_T L.�: �-- e ,r--�, _.-•__. . °- --- ` 7-.5 ._......._.._.----•---••-----Cj ��G !LAf�_hrL� ...._..........------._._----•--- ....... Sly..----------- _ - .._..- — - --/fr/ — --------------------_-.-------------. -.... -._...—--......._. -....._ _ ...........................- I hereby certify th9rnave prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State lows, an rufos and regul ons of the San J quin Local Health District. (Signed)._....._---..._.._.. -..._�!��9�tl�t(`'i"!✓.--- ---.-. -.--.. '.._........_...-__.(Ownerand/or Contractor) A� ----........:: By:_...--..-----------......----------..loof's"s.-i---a.0------- -------- - (Plot plan, showing size of lot. location of system in relation to wells, buildings, ate., can be plec d on reverse side). _ 1 EPARTMENT USE ONLY a i /• APPLICATION ACCEPTED BY..... _ lf .. ... ,,G . . _ DATE..-._-_ REVIEWED8Y5...... - - -.................. . -. -.....- . ..._-....... —._..... ...:._.- DATE----..,E-.......... ...-- .—. __ BUILDING PERMIT ISSUED.------.........---�------------ - — ....................--- DATE - AT -- Alteretiom and/or raeommersdafions /�.r...? .9.:.�P... ..._ ...a.?. -i?C- !- .__._..__._......._-----.........................._..... . .. ..... ... .............._...,,..........._...-...:.---.........................._.-_......._.....-......._.....--................... t , r Z -Z6_ FINAL INSPECTION BY:... - .. .. _. ._. Date....,1_..............._. ..-.-.-.--- UIN LOCAL HEALTH DISTRICT I 1601 E.Haadten Ave. 300 W. ak Sheet 124 Sycamore Sheat 205 Won 9A feaar Ster4lon, Cellfwnio Lodi,Californio Monrow,Califo.nia Traw,C.11fe,N _ ' rt