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FOR OFFICE USE:
<br />5
<br />.................. ............ APPLICATION FOR SANITATION PERMIT Permit No.
<br />........... (Complete in Duplicate)
<br />This P�rrnit Expires 1 Year From Date Issued
<br />mate issuedc�/_....
<br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and n tall the work e ein described,
<br />Tnis application is made ,in compliance with County Ordinance No. 5�4. . rte
<br />JOB`ADDr2ESS AND LOCATION__.. , ..+ `...tile....
<br />Owner's Name._._.._ 7'7..4?r_ 'll._. l.rt. G.•-. z'�7rzrL�?rltk'�rx Phone... .
<br />.._...._.,.,..._...._...........
<br />Contractor's Name....% _.. �.� ..w.,,.,_._.._ ._, _....._._._.«. «_...
<br />f ' _ ....,................ ....... ............ Phone..,..................,...........
<br />Installation wi11 serve: Residence 9; -"_Apartment House Fj Commercial n Trailer Court Q Motel Q Other Q
<br />Number of living units; ./--- Number of bedrooms .!�_ Number of baths .4_- Lot size
<br />_.........._..._._--
<br />Water. Supply: Public system F ] Community system F] Private pll'�D'epfh to Water Table 449, It.
<br />Character of soil to a adeptly of 3 feast: Sand ❑ Gravel Q Sandy Loan C Clay Loam &'- Ciay ❑ Adobe 0 Hardpan aC
<br />Previous Application Made.- Iif yes, dcite j No � New Construction: Yes o FI FHA/VA. Yes Z, --No
<br />3
<br />TYPE OF INSTALLATION AND SPECIFICATIONS: o
<br />(No septic rank or cesspool permitted if public sewer is available within 200 feet.)
<br />Septic is Distance from nearest well.-.lr47...,. Distancca 'rpm oundatlon .-.*� .. .._ Matey1
<br />No. of i d(� V. Liquid deptia -. Ii/ ... Capacity40........
<br />i
<br />Disposal Field: Distante from nearest well Distarca from 'oundaticn./r�'� ...._....Distance to nearest lot line_.%ro....,.-...
<br />Number of lines. ..' � ��..,. De Lengthh o. ��'tterh matc�ria�,>���� ."".Width c+f
<br />._..
<br />Type of filter materiall/4 s i ` , ,.,,7otsl length__.
<br />I �r p i r,e %n''........ J
<br />Seepage Pit: Distance to nearest Well.,•'��t�,� "...Distance f n fo da#ion ,✓!�.��.. ' s' n e to nearer# lot 1ir�eor"f
<br />Number of pits . ..._.... l:i"ninq material._ W .Size: Diameter. c 17ept r,.�G ,r ' �• ��
<br />Cesspool: i7 ,tancc 1."om nearest Weil_................ Distance from 'oundafion...:,%;......._.. Lining r r�terial...
<br />.. ..... .
<br />8'titl"3. _ •w.:y ..w a...•:+Sw.i.rrr-�1.. lquid Capacity '-^'-- ........ r„ i5Is.
<br />Privy: 'Distance from nearest well...._. .... ..... . ...... .....Distance from nearest building...-.... .......... ...._.V.
<br />a ❑ Distance to ncarest lot line.
<br />Remodeling and/or reps' ring {describe}:... / ...."::...
<br />ff
<br />I
<br />I hereby certify that I have pr'i; gyred this application and that the work will be Jori® in accordance with Sail Jtaa jem County r3
<br />ordinances, State laws, and rules and regul tions of Ae San quip Local Health Distric -
<br />(Sigaedl .._".................. r
<br />L✓, y�»� Title .Y �i
<br />( 1
<br />(Plot plan, showing, stzo of lot, location of system i r at
<br />to wells, buildings, ate.. can be placed on reverse side,).
<br />+ FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED BY..�............_......«.............----_.-.. .--- �--
<br />, ---..w.------------- ,_... DATE_ ...... ,...,,..
<br />REVIEWED B"Y.......... _ ...._ . ....... .............
<br />BUILDING PERMIT ISSUED...... ........ . _..........". ...,.. ..... ._ DATE._." . ,,....,......._...,..,... .,._.... ..
<br />�..., . ......._., ...,.. _. DAT E ............. �w .. _.........................
<br />Alterations and/or
<br />l
<br />w ...... . ............,.. �_,.........., .......», . ....... ...... ........... --------- - , ........ _ ...... ..._........".. f
<br />FINAL INSPECTION BY:,.............�........`...40
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<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />1601 1. HaYettaon Ave. 300 West Oak Street 144 Syeamore Street $03 West 9th S+reet
<br />sto4fori, califiomia Lodi, calif-amia mattteca, CaiifCrrtia Tracy, Caiifrrrnia
<br />V"P co,
<br />
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