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PUK UMCE USE: --------------------- ------------ ------------- -------- -------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. 242:2 --------- --------- ----------- -------1-1--------------- (Complete in Duplicate) I ------------ -------------------------- -------------- This Permit Ex fres I Yeas From Date Issued Date Issued 2-0 -7 Application is hereby made to the San Joaquin Local Health District for a permit to contiucf an4 installthe' work erein described. Thi5_application is made,in compliance.,with County Ordinance No. 549. .?j&LCK JOB ADDRESS AND 'LOCATION---- ------------------- ----------------4------ ----- ----------------/----------------------------------------- Owner's Name-------------111A11 - - _ ---- ------ ------ - ---------------------------------------- Pho4 Address I .::�--/110 C, • IL4--------- ------------- ---------------------------- --------------------------- Contractor's Name--- ------ ------------ ------------------ --- ----------------------------------------------------------------- Phone Installation will serve: Residence lk-Apartment House [-] Commercial 0 Trailer Court E] -MotelEj Other ❑ 0/0 0 'Number of living units: __.f_.- Number of bedrooms Number of baths ---I___ Lot size Wafer Supply. Public system El Community system E] Private E4---Depth to Wafer Table 1p ft. Character of soil to a depth of 3 feet: Sand Dr--Gravel [] Sandy Loam []. Clay Loam E] Clay E] Adobe 0 Hardpan El' Previous Application Made: (If yes,date...... ---------) No New Construction: Yes 0 L1 FH�/VA� Yes No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weil_-4;'_0.`----Distance fr ----- - om founclafion-JR-" Mafer'a X:Vdl�� I I--------------- -- --- ------------ ------------ DR-- No. of compartments------2—----------------Size--J ..:F-'Liquid depth----- 2 Disposal Field: Distance from nearest well _/---- --------.--.Capacity---?� ---- Disposal - _Distance from foundation__4,?._'----------Distance to nearestjot line---%5 Number of lines------1--------------------------Length of each line__/_!!�O---------------------Width of trench__!9�_Ie__Z' _Type of filter material---W_04__/r�-------Depth offilter material-Y-k-Z' ------------ -------- .. . _�w -----------Total length_.___/.q_0 ------------------------- Seepage Pit: Distance to nearest well----------------------Disfamfe from foundatic, I--------------------Distance to nearest lot line Fj Number of pit$-------------%... --Lining material----------------------Size: Diameter.-. ---------Depth---------------------------------I Cesspool: Distan�cejrom,nearest weil-----------------Distance from foundation--.-----------------Lining material__.____--------____ ----------%%,� 171 1. Size: Diameter----------------•-------------------Depth------------- -------------------------------------Liquid Capacity--------------------------"-gals.. Privy: Distance from nearest well-----__------------- --Distance from nearest building------------------------------------------ D�s t a n c e-to nearest lot" 'l�_n'e--------- j Remodeling .and/or repairing (describe)______________-_.----_.--_.____ -------------------- -----------------------c ---------------------------------4--------t-------------------------------------a------------------------------------------------------------------------------------------------------------------------ --------- --------------I------------------------------------I----I------------------------------------------------ -----------------------------------_------------------------------------------------------------------- -----------------------------------------------------------------:----------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have iprep ared f his.application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules ander !;ul ions of f e San Joaquin Local Health District. I.- (Signed)------------- ------Z4 ------ --- ---------------------------------------------------------- -----Y_(Owner and/or Contractor By:. --------------------------------------(rifle)----------------- --------------------- ------------------------------------------------------------- ------------_......... . . .............. (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_ REVIEWEDBY ----------------------------------------------- ---------- DATE---------- ------------------- BUILDINGPERMIT --------------------- ------------------------------------------------ --------- DATE---------- ---------- ------------------------------------ Alterations end/or recommendations: -+------------------------------------------------------------------------ ---------- DATE--------- -------------------------------------------------- -----------------------------------------------------------------------------------------------------------------I---------- -------------------------- -------------- ----------------- --------------------- ------- ----------- --------------- --------------------------------------1--------------------------------------------------------------------------- - ---------------------------------------------------------------- !:: ---------------------------------------M---------------------------------------- ------------I-----------------------:-------------------*---------I------- .....................................................--- ------ --- -------- -- ----- - ----- --- ------------------------------- ---- ------------------------------ --------- ---------------------------------- ------------------- .................. ... ......... -------- ------------------- ---------------- ------------ ------------------------ -- -------------------------- FINAL INSPECTIO-LL CW_BY�- BY --- -------- Date------------37r/�� 'SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockto I n,California Lodi,California Manteca, California Tracy,California F-F,E:Q.