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FOR OFFICE USE: I ................ ................................ I ........................ ................ ............. APPLiC.'1TlON FOR SANITATION PERMIT Pe-mit No. . . ... ..................... ..... ................... (Compbfe in DupP�cah) Date Issued ... ... This Permit Expires i Year from Date Issued Q. Application is hereby made to the Sen Joaquin Local Health District for a permit to construe and install the work herein desen'bed. This application is a in co plience with County 04:118 No. 549, JOB ADDRESS A L CA iON..47/Q� /� l� Owner's Name...»......!�!<X/yll .. tf... ... ....._.. . �/.Y..... ..... . ........... .._.. ._......._... °!!oneQ_�t!>__1�� -'.r*' i Address—___.. /.._..- -- , Contractor's PJamr.._... ) -Gr.... .........................._........._.._......_... Phone-1- Installation will serve: Resioence House ❑ Ccn,merciel C] Trailer court [j Motel -�—- -/ Number of living units: ... Number of bedrooms..'#'Number of baths of size ._.- Water Supply: Public s;stem ❑ Community system ❑ Private 0-'*D.pth to Waite-Table........ ft. ' Charactar of-oil to a depth of 3 feet: Send❑ Gra-el❑ Sandy.Loam 0 Clay Loam[I Clay 0000'Adobe[j Hardpan ;? Previous Application Made: (if yes,date................ ...) No [Y—'New Construction: Yes ❑ No [Q--rHA/VA:Yes❑ No :r> TYPE OF INSTALLATION AND SPECIFICATIONS: (No sop tic tank or cesspool permitted if public sewer is available within 200 feet.) . ; Septic Tank: Distance from nearest well..._............Distance from foundation..._-._.._......Materia(..._._...____.._..._•_ _.. _ ❑ No. of compartments............. .........Size.. _ ...__---•-- --_..Liquid depth.._.._.»_......__.__Capacity.___— Disposal ' Id: Distance from nearest well.�_Distance from fourdetion._l..Q-...»._Distance hnearost lot G S Number of lines..._._./........... .._--Length of each line... of trerich— Width .. s, q -6�_ .. ... -type of filter materiel.—S; �� epth of filter material...,lp .......Tai gth_._ -•. •--= 7.0 /�� ;r. 0 ./2Z _Di anco to nearest lo+ /.el: ._ v Seepage t' Distonce to nearest well./li.Tt7...—_..Distance f foundation._ .. ..Size: Diamefbn� ii yy 1� ,;Yk [� Number of pits........I..-.....Lmmg material.� �—.•—.-- Cess,�ool: Distance from nearest well.....:y.._._Distance from foundetion.......__.._.......Lining materal ❑ Size: Diameter..... ..........................'}...Death..._...._........................._.____Liquid Capacity...—: ,-- d- ..ga . pr,vy; Distance from nearest.well......._--.._.--._ .. -____. ».....Distance from neare,tdbuading..........�. -. - Distance to nearest,Iot line........... D' " Remodeling and/or repairing (describo. f ........7 - - - ��r•� c' 'df .__.........�......_........-.»P...�......_ .••-PP..._ —I hereby eerti that I have prepared this a lication and that the work will be done In aceo`fl Vh0mwwifh San•ICW41-i6 Camfy_ ' ordiisances. State laws, and regulations of��the '�San Joaquin Local Health District. _L.,�4/.-e .................................................... and/.sr Confractor). ` Br• Gz ..... .... plan.showing site of W.loco of system in relation ro wells, buildings,ate., can be placed on reverse rdsk� FOR DEPARTMENT USE ONLY - —; IJATF......_f� �1 AC CTED BY........... l..R..�.r »._.�...__.._.......... gr4EDI BY__..._-._----__..»..............................................._•.»�._._....... �_... _ LATE -•.. _�_'__.1+ ..__:_.. �, t BUILjjM PERMIT ISSUED...__ ._..._.._ .__.............._».. ._ . DATE A1*afions and/or recomntendtiQ cis: ............... ............. ... _..».. . .... ..... . _ ....... ..........................................»........-------_.. �J 3 Dots........... L 5.............. . .... . .L. 7J[�.FINAL INS t ». rQ SAN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E Nw haa,sa_ 300 West Oak WOO = 624Syar�ciw 203 W"t 9*Saes- Lodi, aw y' Lod(.Calltarnla Moahta,canfemia Tracy,Cel{iwnb Sioddsr. �.� e,C 4fwn ,,r ss , ti la Y '6L r.►.po.