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PPLICATION FOR SANITATION PERU Permit No. <br /> (Complete In Duplicate) *VVII <br /> Date Issued <br /> Application is hereby made to the Son-Joaquin Local Health District for a permit to construct and install the work harain described. <br /> This application Is made in compliance with County Ordinanc,3 No. 549. <br /> ;> <br /> ............... <br /> JOB ADDRESS AN <br /> Phone... ...... <br /> eme ...... <br /> Owners N . ...... <br /> Add .....................72............ ..................................... <br /> ContracWs.Narne_._'-,_l ....................................... ....... P one............................. <br /> Installation WIN owes .,Residence Apartment House 0 Commercial [3 Trailer Courtw�0. ot LD )her <br /> _9 <br /> NumbervtlivingI units:J_Number of iiedroorris....I. Number f b thill... Lot size 7-- <br /> Water Sopplys! Publlc'rystem'(3. Community System 13 Private;4i$ fry <br /> _Cpth to Water Table !a_ ft. <br /> Character all'soil to a depth of 3 fo&h; Sand[3.'Gravel C3 Sandy Loam O Clay Loarno Clayo Adobejo Hardpan 0 <br /> i <br /> Pre rips APPIc44m Iiilades Yet C)'.'iso P( Now Construction: Yes A No 0 FHA/VA; Yes 0 NoAT <br /> TYPE!OF INSTALLATION AND SPECIFICATIONS-. <br /> (Nii septic tank or'cesispool permitted If puWk I~Is evallelAe within 200 feet.) <br /> Septic Tank; Distance from nearest Dist fro foundation..../L7.......Ma rl. <br /> No. of ciiimpaitments� <br /> S;19!7_X.�.X...5wUquid depth__,):."I Capacity...19ZS__b...... <br /> ' <br /> Disposal Field- Distance <br /> jrorn.nearest woll.A-910-Distance from foundation-ILP...........Distance to nearest lot line..A.0...... <br /> Number of lines-. L Length of each line....... . <br /> ..... ._ ....Width of trench 2- <br /> lype of filter Depth of filter material.. ../.- .... ......Total ..... <br /> Seepage Pit: Distance to nearest,;Yell Distance from foundation....................Distance to nearest lot line............,..... . <br /> 0 Number of pits...................Lining material.......................Size: Diameter....................-.Depth............................... <br /> Cesspool: Distance from nearest Distance from foundation...................Lining material.................................... <br /> 13 Sim: Dlameler.__ �..................-Depth....................................................Liquid Capacity...................... <br /> Privy: Distance from nearest well.»»...........................................Distance from nearest building......................................... <br /> 13 Distance to nearest lotlines.. ...............................................................................1............. 11 ..... ............... <br /> Remodeling and/o; 're repairing (describe):...................... 'S__V <br /> pa &A, P.- <br /> .................................... <br /> ...................... <br /> ........................ .......... <br /> ........ ................................_..................................................... <br /> .. . ...... <br /> I hereby certify thet 1 have pm"redthis bOPP and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws„ &M n4es and r of the San JoaqVIn Local Health District. <br /> (Signed) ........ .. ...... ..ae 40 ...............I...... ..(Owner and/or Contractor) <br /> _..._........_.»..... ..................................................................(Ti itle)......... ..................................... <br /> (Plot plan,showing sins of W,location'of system In rotation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.............................................................................................. DATE..----•...................... <br /> REVIEWED ...................................... <br /> V... . . ..................... DATE........... ..... <br /> BUILDING PERMIT ISSUED..._.._.. ........... . . <br /> ................ Z.............. DATE...................................................._..... <br /> . . <br /> Alterations and/or recommendations;..........»»_......... <br /> .................................................... ............ <br /> 2AR <br /> o—eflon <br /> U <br /> ..................................................... ............................................................................................ ............ .............................................. <br /> .........................................................................I.............................................................................­.............................................................. <br /> ........................................................ ................................................................................ ......................................................... <br /> ....................................... ........................ .... ..........I....... ..................................................................­......­............................. <br /> .. . ........ .. <br /> . .......................................... <br /> FINAL INSPECTION BYDate..... . .... ........... <br /> ................. ....... ............ <br /> SAN JOAPUIN LOCAL HEALTH DISTRICT <br /> 130 South Amrican Street 300 West 06k Street 112 Sycamore Street 014 North "C"S#rW <br /> Sf*cktoft. "ifornis Lodi, Califerpla Manteca, California Tracy, Califortla <br /> ES--9-2M- Revitoo 1.57 F.P,CO. <br /> �T' <br />