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�.w FO7CE ac _ _. • Permit o• AppL)CATION FOR SANITATION p>ERMI l/ l DateIssuedL ----- = (Complete in Duplicate)y .-'` ' This Permit Ex +res 1 Year >From Date issue - -- - permit to construct and install the work herein describe . . . .... . made to the San Joaquin Local Health District for p p,pplication is hereby fiance with ty Otnance No. 549 �}I ��c /�Y """""" lication is made in compo r✓Gz �--( -" f This app _Y"V JOB ADDRESS AND LpCATVON__.--- ,. Phone_ ------•----------------------- LA f .N-- _._. Owner's Name -- - one. '`-------- - - Mote; ❑ other ❑ Contractor's Name____.._ " E Commercial ❑ Trailer Court ❑ KNUrtmen{ l-•louse ❑- �SC� __�Lot size -------Numberba{hs��Installation will serve: Residencer of bedrooms i _ ft.Number of living units: " Private ❑ "Depth to Water Table Hardpan ❑ community sys#em + Clay [] Adobe i l Public system Sand Loam❑ Clay Loam ❑ VA: Yes �`I" ❑ Water Supply. Gravel [� ,. __ ❑ FHA/ Lam' No New Construction: Yes k Character of soil to a depth of 3 feet: Sand ❑ Application Made: (if yes,date, , : previous App A';kj ublic sewer is available within 200 feet.)/ yam!�"�!---"--- TYPE OF INSTALL, AND SPECIFICATION I y� M t ril__ -� r-_"-Dis#enc fro foundation__ U-- (No septic tank or cesspool permitted if p th Capacity-J. F --------- Liquid dep. Distance from,nearest we - Size_ Septic nk: r r."_""-Distance to nearest lot line".. ---- e — I -------------- S No- of compartments"" �" Width of trench . ' istance from nearest well_._` Distath ofreach lne a } �� ! _._-"" Disposal Id j Leng Total length" .3 € Number of lines_---- i7 Depth of filter matertal__��-- + II Dep -Distance to nearest lot lief Type af'filter:material'}�- foundation._ v ------ Sze: Diameter. ------ --- --Dep th Distance to nearest well._----- Distance Seepage it': Z - - `` JJ Lining material-_-- - ! `� Number of pits----- --- - gals. \ --------------------Uqu id,-Capacity--------------------------- i -. from nw a est well---------- Distance from foundation---------- Lining materia ._.---= Cesspool: .Distance '\ Depth_ --------- s ❑ 5ize: Diameter-------------- pistance-from-nearest building ------... f �, r' 4 _______________________"-___- Privy: Distance from=nearest:wel4.--------- ------- ❑ .Distance to nearest lot line- ------- ------------------------ •�' ---------:.---•---------- ------•-------------------------------�-- ' �1 ,� ---------------- g ( -------'- ------------------ __ --- - ---------- Remodeling and/or:repairm escri ey__"_---- - ---- _ ----------------------------------- --- ----- -------"""-•- t ; x• h. - -------------------------- --------------------------- ------- -- - ----------------------------------------------------- -------- - --- - ------ ------- - that the work will be done in accordance with San Soaquin County ------- ---`--"-"_____________ prepared this application and ) I hereby certify thatTe ah�have and egul ions of the San Joaquin Local Health District. or Contractor ordinances, Stat la. - — (Owner and --- ---------------------- --- -- ------ ----- ------- --- ---- Titl - --------------------------------------- (Signed)'- �� laced on reverse side). QY _ ----•-- -- - �-- -- buildings, etc., can be p [Piot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY T ------------------- _. . ------------------------------ DATE_..----- --- lGe APPLICATION BY____...-----_ =_ + ------------------------------------ ---------------- ACCEPTED. DATE , -- --- ---- ---- ------- DATE.----- ------- .�- ---- -- --- ------------ - ----- --------+�--. REVIEWED BY ------------ -.--------- sir- kc'". ------------ BUILDING PERMIT ISSUED" _ hil' r t li - - o _ I G . -K----------------------------------------- Alterations and/or recommendations:____.---1� 1_4 r-r •----- -- - --- .t__.. Date_ .._ -- ---- i FINAL INSPECTION BY:-------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 205 WesTff i 124 Sycamore Street [ 300 We oak Street _ jl4anteca,California Tracy,G 1601 E.Hazelton Avg. x t Lodi,California Stocklon,canfornia F.P.G q.