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FVKUYF]CE UE` 30 ^` rI ................- - -------------- --------------------- ........,1/;.. .aAPPLICATION FOR SANITATION PERMIT Permit No. . p R (Complete in Duplicatel ! --------------- ------ This Permit Expires 1 Year From Date Issued Date Issued --_? -/-f?-� Application is hereby mifd, to the San Joaquin Local,Health District for a permit to construct and install the work herein described. This application is made in compliance wifh County Ordinance No. 549. + i JOB ADDRESS AND�QCATION---- ./j-�/ff �� 1 ---=-------------------------------------------------------------••------------------ \ Owner's Name �� '-- ------- -e-ca.2Gh -- - ------------------------------ ---------------------------- Phone Address - -------� / - Contractor's Name--------- . .- d ------------------------- -------------------------------------------------- Phone----------------------------------- Installation will serve: Residence fpl�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1-.. Number of bedrooms__ Number of baths __ Lot size Ox--_-xj-V*!!: Water Supply: Public system �Community system ❑ Private ❑ Depth to Water Table,��_7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date________________.__) No ❑ ..New Construction: Yes [❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .Septic T : k Distance from nearest well----- ......Distance from foundation---/Q.� No. of compartments___._--.-- _ '°°_-_,Size. f�._4.OLiquid depth------- -�.-...-.______Capacity---�- _ �4 M. Disposal d: Distance from nearest well._._`.A_..----D.istance from foundation-- ----.Distance,to nearest lot l�, e - �.---_- [ Number of lines---.---.__�-_... .... rLength of each line-,_74 f_Z5 -.Width of'trench___ ------------- Type,.-of ____________ p , !\\ Type,.of filter matenal-___.�.-/Z-._._ h of filter material..-. '--_________-Total length-..__ I--_----------------- W Seepagit: Distance to nearest well---.-" "". --Distance fun anon-- D- -._-- Distance to nearest lot line__ ---- Number of its_ --------Linin material-- � .-:.Size: Diameter __ l/ . ��y� A � / g ��Q - �--�--:--..�.Depth---L`��--t --- �'`t -, L Cesspool: v. Disfancer from nearest well____�-----------Distance from foundation------------------_Lining material--------.. - ---------------------- L1Size::[}iameter f .-.. _ ----------- Depth-----------------"--------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_,-� - --------->-------------------° -- -Distance from nearest building----------------•------------- - - .� ❑ ' ,w; Distance to nearest lot line_ ----------------------------------- ------------------- -- --------------- --------------------------- - ---------------- Remodeling and/or repairing (describe): --------- ----------- -------- t�.r1✓-------------------------• ------------------------------------- --------------------------------------------------------------- -----------------------------------------5'"---------------------------------------------------------------`- I hereby certify that I have prepare-d-thi3-a*i Wii-o ardrthat`fh o k will-be done in accordance with San Joaquin County ordinances, Sfa �a3ws,. and rul d regulations of the San JoaquinlLocal Health Disfricf. (Signed).-------. rD.C� --- (Owner and/or Contractor) --------- _ --- r----------------------------------- ------ - �r`- - _.. ------------------------------------ (Plot ----------------------------- {Ti+le) ��R- R;'� (Piot plan, showing siz `of t, location of system in relation fo IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY- ------ --------------------------------------------------------------'DATE------ ---- i ---------------------------- REVIEWEDBY-------------------------------- ------ ----- ------------------ --------------------------------------- DATE BUILDING PERMIT ISSUED------------------------- - DATE.-------------------------- --------------------------------- / j = ' + Alterations and/or recommends+ions: - j --------ter x--�----- - -�`r�� - II J s -----�=�--r`�------�s��-._o�n�.. .,f[.C.�- - .--�P�'f-� �•-oC _.a�-/lsatae�.A.C.e�.�-t.�+� -_.�.�.r- _ m� r -------- - �-� , �� - - ..-- / �.�.��. -<--- e- -------------------------- ------------------------------ ' 1 ` FINAL INSPECTION BY:- -- ----------------------- -------------------- Date-------------- ---------------------------------------- - --------------------- { SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. } f 300 West Oak Steel F724 Sycamore Street 205 West 9th Street y 5tocklon,California Lodi,'California 14anieca;'California Tracy,California r.P.C U.