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3 � Id( c.✓ . as , f I APPLICATION FOR SANITATION PERMIT Permit No. ._ZZ.l..>l .�— (Complete in Duplicafe) Date Issued ...��9 1GO. Application is hereby made to the San Jroquin Local Health District for a pe:mit to construct and install the work herein described. ku This application is made in compliance with County Ordln No 549. JOB ADDRESS A CATIUN.. -(O/�_ (.r._ �(,%�CGjj -J .. Owner's Nerne...... f..N....................4/...57/.1 . ....... Phon S"�lfkJ` ..__ .. __ _ . _ bw Address.... . _.._�..... ........ _... Contrarior's flame .......L .. O�F�Y'r� .._.....-............... Phone .(f/..-�.�� .. _.... Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r - ►' Number of living units: -1..... Number of bedrooms 1.... Number of bat,ls .15�)C../ ..._ Lot size . .................. , Water Supply: Public system ❑ Community system ❑ PrivatejRLDepth to Water Table 40. ft. Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam X Clay❑ Adobe❑ Hardpan❑ Previous Application Made: Yes ❑ No X " New Construction: Yes;< No ❑ FHA/VA: Ye, rl NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. Sepfic Tank: Distance from nearest well_.Srf..�....Distancfrom foundation.... ._r_..Materiali.t'M!•! . /._.. < ............... No. of compartments-1.. . depfh_S:Q�_...........Ca aci G.l-� Disposal Field: Distance from nearest well. �DQ.�.....Distance from foundation.... .. Distance to nearest lot line. 1cr` ...T ... .... -... ... ...........Number of lines.. ..&.1- Length of each line... .. .. Width of trench-107-4f .............of filter mater 70. WC61.<De th of filter matena length ..............5,A7',-__ Saopoge Pit: Distance to nearest well......................Distance from foundation...................Distance to nearest lot line.............._ ❑ Number of pits.....................Lining material................_...Size: Diameter._........... _...-..Depth......._.........._._.......... Cess.00l: Distance from nearest well................Distance from foundation.. ............Lining material.... ❑ Size: Diameter.. .-,,,........ .. ......_......Depth........ _.............. .. .. ........Liquid Capacity............................gals. Privy: Distance from nea,est well.... ........ .............. .._........_Dinfanc, from nearest building.. _ r ❑ Distance to nearest lot line ... ........ ._.......__._ _.... .............. . ..._............__.._........_...._......__._......._......._.._. Remodeling and/or repairing (describe):.._.........�_ 9./.!✓. _ r + yyy C` .. ......................................................... / ... ...................-.... ` ....................... ......................................................... .. ... .--------------.......................... ..... ................. .......... .-- . . ..................................................... .. ................ .. ...... .. .... .............._............. I herebyy certify�hat'( a prep ed t •s application and that the work will be done in accordance with San Joaquin County ordinances, Stale,l(ws, an i rules reg ations a. / s / = Sang�Joaquin Local Healt'-QDistrict. (Si redI�� ....�� C . _ .._ _. Owrearandror Contractor) By:. .................... .... ..(�1Ci....._�,. .... .�ij(•._(Title) j ��... . ... ._..__.. _. (Plot plan, showing size of Io, oution of system in relation to we Is, buildings, etc., can be plat d n reverse side). bw _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... ./l. J •G�. " . .. .......................__......_..... DATE..- /_.'.. ..-.... J REVIEWEDBY...._.._.........._..........___..... ..._ __ _.__..:__ .......... . .. DATE.............. ................... _..._...._...._...... BUILDING PERMIT ISSUED..................... .-_............ __. DATE..... ...- --- ...._. Alterations and/or recommendations:..._._.......... ... ._.. ............__. .._......_. ........... ..._ . . .... ......._... . . . _..:....._ _ ... ._ _..._.. ye FINAL INSoECTION BYi,:�-�wy�.. 1. _.. Dale. SAN JOAQUIN LOCAL HEALTH DISTRICT L 130 South A,ner:can Stree} 300 Went Oak Str..t 132 Sycamore Sfnet 814 North "C'Street StocNon. GGfornfa Lodi, CeCfornie Men}ata, CeCfornie Tracy, California c.9-2M tied;ca i.57 F pro 6.