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r'UK -------------------- -------- ---------------------- -------- --------- -------- --------- ------------------- APPLICATION FOR SANITATIO N-PERMIT Permit No. --------------------------------------------------------- I ------------ ---------------_---------------------------- {Complete in Duplicate) I `%))`A� Date Issued t t Ex. fires 1 Year From Date issued Application is hereby 'Made' to the Sail Joaquin Local Health District for a permit to construct and insiii'll-the work herein described. This 1papplicafion is made in compliance- with County Ordinance No. 549. f08 ADDRESS AN&LOCATION. ? Nnl V__ .....lzic".,eqw............. 6wner's Name-------- .. .. ...............—------- _�..... ------------------- - ---------- Address ----------- .............................................................................................................. Contractor's Name -------------I-------------------------- -go'hone.------------------------------------ -------------------- ., I-, . %. ... ..................I........ tment'House, 4 Installation will serve: Residence' ❑ A15' , - � 1 -1- 0, Commercial E] Trailer ISM g Motel 0 Ot,hb' r E]vi C4411-d-i Number of living units: --/---- Number of bedrooms--------- Number of,Kaths ........ Lot size ..........6 0__`_X2,/.2p!�............. Water Supply: Public'system IR Community system t] Private L] I Depth to Water Table ........ ft. Character of soil.to a depth of 3 4 feet. Sand - Gravel F Sandy Loam j Clay Lam : Clay 3 Adobe!EI Hardpan E Previous Application Made: (If ye's,40te--------------------) No D New Construction: Yes Q No [I FHX/VX Yes [I No ❑ TYPE OF,INSTALLATION AND SPECIFICATIONS; ' (No septic tank Or csssPOOI Permitted if public sewer is availabi;'w'i4h'in200'feet:' Septic Tank: Distance from nearest wellA/4?��_*Bistance from foundation----A0.........Materie nts--------- $ , -/ 11--7-- 4_ No. of compartme' _-Size--- --------3-7 g Liquid clepth_--------- capacity .flG Disposal Field: Distance from nearest wel&6��__*Distance from foundation---------- --------Distance to nearest lot line................. 1R Number of lines------------- ---Length of,�each line----------60--- --------Width of trench----.-_. 'Type of filter material. A Je ...... Seepage Pit: �-Depth of filter material-----41----- Total length..'._....._...16ja---------I- ------ to nearest well--_-__-_-_ Distance from fZn_da�j_o___.____ T""-isfance to nearest lot line. foundation___________________.Distance D El Number of pits...--------•----------Lining material----------------- ------Size: Diameter-----------------------Depth------------- ........ ....... Cesspool: --------------1-.1.0 Distance from nearest well-----------------Distance from foundation--- ----------�-__Lining material--------- 1.0, IF] Size: Diameter------------ -----------I—----------- -------------------Depth-------- -------_--------Liquid Capacity----------- ----------- ------------- i � " .............._g4ls. Privy: Distance from nearest well________________ :: El Distance to nearestl:lot lfine_______________ from nearest building---1------------------------------*-------- ------------------------------ ----------------------- I------_------------------------ Remodefing and/or repairing (describe):-------------------------------------------------- ----------- I .............. -•--•-•--.....•-.....•......m............................... ....... --------- --------- -------------- k-j .1 --------------------- ------- --------- ........ -----------*---------- do ------ ------------------- ........ ---------------- ----------------------------------------------------------- ------------------- - --- - ---------- ----------- d this applicafic�n and that the ark will be done i6 4ccordance with San ---County ordinances, hereby certify that I have prepar6 ------------------------------------------------------------- ordinances. State laws, and rules and regulations of the�San J_ w i Joaquin Local Health District d .. -------- ............. ....... (Signs ---------------------------------- -------------------------------------------------------(Owner and/or Contractor) By:------------------------- I I •-------------•---•------------ - -------i----------=-•-----------•----` I fle)------------------------------------------ ------ --(Ti (Plot plan, showing size of lot, location of system in relation to-wells;---buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- 7 DATE-----------4 - -- --- ----------*---- ------------ -------77� REVIEWED BY j I------- ------------- -------------* I --- ---- -------------- --------------- -------------------------------------DATE------------- BUILDING.PERMIT ISSUED-----------_- - -------------------! 4 .__ ............................................... -------- -------------------- DATE--- t". - Altera ion and/or recommendVat' ns:_- t. I a --------------------------------------------------------- f -- ------------ -•-•---•-- --------------------- - ------ - - - -- -------------------- ---- --------------------------------------------------------------------------------It ------------------------ -------------------------- --------------------- ------------------ I------------------ - ------------ ... ................................ ------------------------------------------------------- ----------------- ........................................ A , .__------------------------------------------------------------------------------------------------ ----------------------------------------------------------------- I, ..............I..........------------------------------------ ---------------------..................... FINAL INSPECTION BY:__-"................_�_ . . - ---------------••. ----•--•------ Date-------.._. SAN ate------- SAN JOAqUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California 20S West 9th Street CS 9 RFVII;ED 0-59 RM 5-61 ATLAS Lodi,California MOrtlece,CaliforniaTracy,California