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APPLICATION FOR,SANITATION PERMIT Permit No. __�_?(J_-{J_.__
<br /> {Complete in Duplicate]FT
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<br /> Date Issued y9 _f S�v
<br /> Applica+ion.is hereby made:to tFie`SanJoa'quin Local Health Disl rlct for.a per it to cons1.truct'and instal the work #ger in de tribe
<br /> This appljcation,is made..in c'omplian'ce r ith County.Ordinance'No. 549', a�
<br /> JOB ADDRESS.AND ILOCP,TIO. `gt
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<br /> Owners Nam __..__ ,1111111111111
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<br /> Address '- F N� `
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<br /> Cont-.actor,.s,_Nama- ]
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<br /> will serve Residence x , Apartment House ❑ ~Commercial ❑^Trailer-Courtk ❑ otel'❑ i Other ❑
<br /> Number of IlvmI units i Number of bedrooms Number' baths Lot,size
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<br /> Water"Supplyi Public sLysta ,❑ ` '4Cori5niunit"y-system'❑ "`PikGate Depth to Water Table.:.-'-ft*-' F
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<br /> Character of soil to_a depth of 344 Send.'. " Gravel [�_ .Sandy Loam' _.Glayloem[] _Clay.❑. Adobe [goHardpan
<br /> Previous-Application Made: -Yes ❑' No ;-; New Construction:->Yes �o ❑ ',t_ ,.._" r
<br /> TYPE OF INSTALLATION-AND} SPECIFICATIONS:
<br /> (No septic fan-- or cesspool permifited if u lic4ew r 1s ava,ilable-within:Y00,fee . ,
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<br /> Septi. ;rt Distance #rom nearest wel .__/_- bistance� fro fou dt1on� Mate l
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<br /> .No of r ompartments_-_-- --- id__t-..�._ Size - - -•---Liqulc eptli
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<br /> Disposal- a
<br /> Field•- �rDistance, from;nearest-welt:0Disfance from foundation Distance to nearest lot
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<br /> r tNumbbi of:iines- f , `Len th of each line ± _. i�
<br /> g a 1 ---,Width of trei}ch_
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<br /> Type.oT.filter mater + epth of filter material Total' length_____ ±--
<br /> Seepage Plt: . Distance to.nearest wail Distance from foundatro�ny""`` _.Dsfance to nearest lot'line____ _
<br /> N of
<br /> Cess❑p�ool: � ,+. �D stance fi om"Snearest"well---��n��'mDistan'--- �.--. .-..- $ize Dlarnetei�--'- ' --•:----Depth----------' ----------------- -�
<br /> ce from fourid6tion R Lining materia
<br /> >-tSize' Diameter_. # I De th_� -==:"_:I .!. _ __'Liquid,Capacil t10
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<br /> � .,.,, ..-1-. - •-, t *-r-«�-� .• - .. -----------•--gals. y
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<br /> Privy:-❑ Distance rom`nearest swell :. fi Distance from nearesf build-
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<br /> +'""�"'*^*Distarice to nearest;lot�line -__-___ ~*1 w- � �-� 41 ""' • - s
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<br /> Remodelin and/or: re airin describe :- LL1 '- '_
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<br /> lihereby certify"fhat l haveiprepar'ed this application and that the work'will be done in accordance w'sth San Joaquin County
<br /> ordinances Sfa a laws,'.and rules and regulafions,of_the-San Joaquin LOC ..Health Disfrict,
<br /> (Signa] ---- x _. ,e+-y, �- - �` ---- LOwner end/or Contractor)
<br /> BY-•--------------------- -------------------------------------'-----=----,-----`------------------- :----------------------- 'r=`---- „{Title] -----------------
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<br /> (Plot plan, showing size of.lot, location of system in relation to wells, buildings.'etc.; can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BAK' # f -_ __:_--_ - _ I
<br /> ----------• - - DATE^ ` ------------- ----------"--- -
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<br /> REVIEWEDBY ,. ' -. . ----------------=-----=--------------- ------ _-- DATE- S--------- -----------------------------,-------
<br /> BUILDlNG PERMIT ISSIiED____-=_-::-- t - t t ,
<br /> ---------- DATE. Ra
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<br /> Alterations and/or recommendations: I 1 __:
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<br /> FINAL-lNSPECTIONBY:.-"^� E `
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<br /> Date._- ' --�.. �'-�--•.
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C” Street #
<br /> Sfock+on, California Lodi, California Manteca, California Tracy, California
<br /> h.Li--rJ--'LM 135946 ATW
<br /> �2-sa
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