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.1 ;S FOR OFFICE USE: : . -. ........ APPLICATION FOR SANITATION PERMIT Permit No. ..�S�. Q,�:- (Complete in Duplicate) « ?' This Permit Exaires 1 Year From Date Issued Date Issued .. ....�� G�' ..................PP.......-........ . . Application 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 Ordinance No. 549- JOB ADDRESS AIN OCATI �`v. r 10� l�'�12 •`• LJ!`-�z�'... ............._�tlt,{�,v..1...�' ,.......--....._ Owner's Na ......... `!! T:. I..-.-�.z, c..,�C_../��C,(�' 1 ~'•sf Address..._✓ ��.........1.�"/ v . Phone. _............_.._ -f- a.. J ._... ........... ...� r1. t:Contractor's Name............. ..._.....__............._.........-................._......«.__... _Phone..Installs+ion will serve: Residepertment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.../.. Number of bedrooms__. Number of baths ....L. Lot size ....... :71.�.: .._ �k• We+e,- Supply: Public system ❑ Community system ❑ Private (l7( Depth to Water Table .tq_._ ft. n 4 Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam Clay Loam❑ Clay❑ Adobe❑ Hardpan❑,:,.. Previous Application Mede: (if yes,date............... . .. No New Construction: Yes No FHA A:'Yes❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ,^�� jy*•. �} (No septic +rnk or cesspool permitted if public sgwer is available within 200 d' � feet.) Septic Tank: Distance from nearest well /��2...Distance from foundation......a.......Materiel................_.Q._l............ .4 rr No. of compartments.....?.............Size -_ V S Liquid de th-.._ `........:....Capacity. Od ;e Disposal Field: Distance from neer st well.. �� -=_ �; 1' P ,q � ...Distance from foundation__.__-.._.♦.. Distance to nearest lot l* er Number of lines.... __.._». ...............Length of each I ine1Q_-_7.1.:_.. -71 ..0.=_VC42iA of trench .._2. .�:.�..;: .. .Type cf filter materiel-$-.�.-l:f� �LDepth of filter material.-r/-r4 L r --Total length ..y2,.1 • .144 Seepage Prt. Distance to nearest well............:.........Distance from foundation............«. Distance to nearest lot.line» t � ❑ Number of pits........._............Lining material.............:... ....Size: Diameter.__ r :.:..:_......Depth t ' r i Cesspool: Distance from nearest well.................Distance from foundation.... ::_.._.Lining materiel.. cy ❑ Size: Diameter-,.....:........:....................Depth.._.....:...._.._._....__.........._.._.._...»_._Liquid Capacity als. Privy:, Distance from nearest well....................:_..._......................Distance from nearest Distance to nearest lot line....... :r y� Remodeling and/or repairing (doscribe):. ? -._..1.:....._-J_: ._.. ..._hrxl,...._ c x: �Jl.-:�-... ...s.«_C rXJr .......... .__.... -------------------______•_._.__........__.»._.__.....-_____-_«•__....'••---•"•'•'•._«....._.__. _.................._..• ..... ...« , ' >s _ ) hereby cert that! ha a pre red this applicatigtf`and that the work will be done in ac.Cordance with San Joaquin .......Counfy " w ordinances, tat' I s, and- 11 reg tions of t >�' San Joaquin Local Health District. ! S w (Signed)l��. »__.. .......................................................... ...... e a _ .............. ... _...�. -•• •.•:_._•...(Own(Owner Contractor) Plot Ian,Showin« size of lot, location of s ste in relation to wells, buildings, etc., can be laced on reierse side) •� s BY (Title)_-. _ y r - FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY........................................................... ._:._. «..._._.._.............................................«_.._..__....... .._.,. ATE--_•- _...__.... _.« _..:_. ... ^ REVIEWED BY............ � . :.1. ATE _.'........._.................... BUILDING PERMIT ISSUED _................_._...................... N. DATC..._........__....»_.. .......... Altera+ions and/or recommendations:._.._....................................... --. . . -.» _.................:....._....__.._..._...:........_ ...__...._...------------._...._.....••-....._-••-••-------'•-.._.._._......._.........__....._.... ...._.:.._................_......._..:.... J ................................................:__.._. _.._.-._._..._....__..._.............._..........___-.__._...................._....._...__-..._---....... ..-......._.._..-...:»........._............................... ......... ....«..:_._.__...-:..-.............._.__ . ....... .................................................................. ( FINAL INSPECTION BY Date......._.- _. ......................»...... . ................................ .. ' SAN JOAQUIN LOCAL HEALTH DISTRICT ! ". d 1601 E.Hatelten Ave. 360 Wast Oak Street 124 Sycamore Street 405 Wad 9th Street p Stacklen,California Lodi,California Manteca,California Tracy,California i � J Z111 9 nCV!n Ca 9.6e 9M 9.467 r.P.CO.