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' AddressAPPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) \o Date Issued cle to the San Joaquin Local Health District for a permit to construct and install the work herein de ibed. Application is herey This application is made in compliance with County Ordinance No. 549. -4,go .... ....> Z V --_----_. � Contractor's Nome- _ea---jilc ------------------------------------------------------- Phono.ly-g.-t��.��,��'. Installation will serve: Residence [5, Apartment House 0 Commercial E] Trailer Court E] Motel 0 Other E] � Number of |Vngunits: ---I--- Number ofbedrooms3-- Number ofbaths Lot size ----------------------------------- Water --_-----_Water Supply. Public system El Community system El Private g- Depth to Wafer Table .Jr-_ ft. Character ofsoil to a depth of feet: Sand [] Gravel [] 3uo6y Loam E] Clay Loam 0 Clay [] A6o6oJQ Hardpan 0 Previous Application Made: Yes E] No 0, New Construction: Yes 21 No [] FHA/VA. Yes 11 No E] TYPE OF INSTALLATION AND SPECIFICATIONS: m septic tank or cesspool p�nn|��6 � public sewer bm,a8a6|ew�Gn 200 feet.) ` �� , ,�� -�� Septic Tank: Distance from neu,o,+ we| ~--.Di,+nnce from foundo+in.��..-/-----��oferioL-.x:� ----------------------------------- No. ofcompo,+mon+v��-..2%�-�-��-8zo---3\� �� �� ..��_-U � -----' ' Disposal Field- Distance from tf49 / from foundation .. EA- Number of linesLength of each |in;iii-46W.° -YVi6t� of �----------- Type - - � Typn of filter mo+oriaL' �� --D=p+h of fi|+o, mo1oriuL.I��---.Total |ungfh.� ..-��- -_. o / e��-^ i+: Distance to nearest weU16 -------------Distance from foundation--/O--' Distance to nearest lot ----------------- IR Number of pits-A—-----------Lining motoriuL. -.3izv: Diameter..u��mP--------Dept 6- ----..^----.. Cospoo|' Distance from nearest well-----------------Distance from foundation--------------------Lining material -----.-_--'_ [] 3�zo: Diameter--------------------------------------Depth------------------------------------ --------------Liquid Cuoucity--�-'-��'-�gu|s. Privy: Distance from nearest w*U--- ---------------------------------------------Distance from nearest building--------------------------------------- - -�^ [l Distance to nearest lot line------------------------------------------------------------------------------- -----------------------------------------------_---' � Rvmo6eling and/or repairing (describe):----_--'__-_-.--..__.-_---_-_-__-._.—_._._-_----.__.. _-___.-_-___'----'--.-__''--_---___''-__.-''-'--_-_--__.''-_.'---'--_----''__.---'--_-'-�----_-_. --_--_---._._--__--_'_----._-_'.__---__.--_--__-_-----_--__-__._--_-..__.__---------' � --'-'---''-----'---'---''--'''----''---'-------''-'--'''--'--------'---'--'''-'''---'---'- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-,ii ules and regulations of the San Joapin Local Health District. (Signe6)--. ��411�---�A -------------------------------------------(Owner Contractor) By:_---__--__.__..___-__--._�=-..�__-._-__---_-_--__-'`.-le)------ __.'---'---_----_--- (Plot plan, showing size of lot, location of system in relwflon to wells. buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y_-------------. ---_---- DATE--------------------------------------- �L RGY|GVV6D D�L'-''---'---''-'''— --'- DATE � �- -- -�---'' QU|LD|N�� PGRW|T |SSUED_'----'--__'._-__---1.�-*��--�--_--.__. DATE--/i-------.'-----_----_-___ Altm,uHonoanJ/nrrwcommon6mtions:-------------------------- ------------------------------------------------------------------ ---- ------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------- ---''��--------------------------------------------------- ---------------------------------------------------------'� ------------------------------- ------------------------------------ ---'-'--''--'''-'-'' ''---''''-'''''--'---'--''----''-''-'-''-'''-' '---------------------' ----'------------'--'---'—'--'---�-- �� RN,�L INSPECTION BY�---..��._------'--------.---------- Date_----------------^---------------'��—. SAN JOoAC>U0N LOCAL HEALTH DISTRICT oo South American Street 300 West Oak Street /nu Sycamore Street ow North "r' Street m""em". California Lodi, California Mumm*°, California Tr*"r, California ES-9-2w n°./=v )'orFY.cn. --