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r+ APPLICATION FOR SANITATION PERMIT Permit No. f•C- 7 �. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein demmlmd. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...........21};+5.......North Wilson 11iey ».......... ...... ...._...._--.... ................................. Owner's Name...............Connell Motors Company-....................... ............................................ Phone_........ . _ -----. ................................................ Address. 2111 North Wi1�On...WBY...................._.........................._.........._.............� 80f�—�0'� ............................................................. Contractor's Name_ . . & 3Oas............... ............................................................................. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Tr �C ep el 11 MototMr Number of living units: ....... Number of bedrooms ... .... Number of baths ........ sn ............. Water Supply: Public system ❑ Community system ❑ Private m Depth to Water Table _45ft, Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Gey❑ Adobes Hsrdr»n❑ Previous Application Mede: Yes ❑ No IX New Construction: Yes ❑ No Is FHA/VAt Yes❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ... ......... ... ._. ...... Septic Tank: Distance from nearest well.................Distance from foundation............... Materia.............. Eai ing No. of compartments....... ....Size..._.......................—Liquid depth........................Capacity......._._._._.__.. Disposal Field: Dis+sato from nearest well .... .....�jODistence from foundation... �r..0...._...Distance to nearest��OWL ---.�f..--..- Number of lines......... Long*. of each line....1.00 8w•..•...•Width of trench.-PEI - OCiC Depth of filter materiel.......1..0............Total long+h-_.-_..._.._. - ----- ; Type of filter material.....•....... ........Dep Seepage P't: Distance to nearest well.....................Distance from foundation—..... Distance to nearest lot 60e........�� f pits.....................Lining materiel.......................Size. Diameter......................Depth....... ❑ Number o Cesspool: Distance from nearest well............ ...Distance from foundation... ...............Linin material....... ❑ Size: Diameter..., .. ...... .. . . _ ... ....Depth....................................................Liquid Privy: Distance from nearest well. .. ........Distance from nearest buildin¢ ❑ Distance to nearest lot line ... . ..... ......................................_.... . .� ..................................... nae areae .to e.� s . ,II .. 7. �o fS _gr.. ala!!t Remodeling and/or re airin (describe):.. -• house trele . salsa...Yard................................................................ _.._.. ..-.........»..�...........��. ...._........_. .......................................................................................................................................... ........_......... ......................................�.._....: .:: . ... ............................. ................................. . ... ....... 1 herebcertify that I haw prepared this application and that the work will be don*;n accordance with San ordinances, J@OqVb C4111 State laws, end rules and regulations of the San Joaquin Local HeaHh District. (SignedL...............Pa.z'riah.. ..�.Oina...... . .. _.. .. ........................................ ....... ..................E�(own«and/W Ces*60.e / 1 Bill right ... ................................(ptlei............-....-.............................. .._.�..... By:........................................................ ... _.. (Plot plan. showing sae of lot.location of system in relation to wells. buildings, etc., can be placed on reverse side}. . FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY....TiKJ0._......... ............................................................... DATE.......3..:I.I..-..5 .......................... REVIEWEDBY............................................. .......................................................... DATE..................._....................................... a� BUILDING PERMIT ISSUED.............................................................._...................................... DATE............................................. ._...._.... \ Alterations and/or recd a .... :... ............._............................................................................ .. .................J o ......... � ....... �.ni.. .......... ,........_............................................................................_........_........ ..............................:............................ ..............................:....................... .......................................... ....... ............ --.�.....�..� ..... ................ .................. .. . . .. .. . ..................... .F FINAL INSPEC Date........`!....l.V.... ........................_......_...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Arnerioan Shed 300 w„t oe► street 132 Syaarnare Street 114 N” "C'f1ne1 stemten, California Lodi, California Maateea, Califernla Tracy. Camemia Es--9-2m Re,haa 1 57 F v CO.