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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Na. (Complete in Duplicate) -------------- This.-Permit-Expires',I"Year From Date Issued Date Issued ------------------- --- ----------- ----1 7" . Applica�iion,is-h;reby made to the San Joaquin Local He�al+h District for a permit to construct and install the work herein described. This application ismade in compliance with C Ordinance No. 549. oun -------------------------------------------------------------1------------- - -- ------- JOB ADDRESS AND LOCATION.7-` 20 ------------ ----------- .. Owner's Name-------- k.- - --------------- --- Phone------------------------------------ I - - - ------------------ ------------------ ----------------- ------------------- 4. Address-------------- In. ----LA-)1-4- -)---I Lf I Z &!�------------ zz=t:3------------------------------------------------------------------------------------------------------ --------------- Contractor's Name-------------- /------------------------------ ------------------------------------------------- Phone------------Lpr----------- ---------------------- --------- -6mercial ❑ Trailer Court [I Motel 0 Other El Installation will serve- :Residence Apartment House: 0 Commercial Number of living lunits: ---3-- Number of bedrooms Number of baths -J Lot size Water Supply: Public:system 21rl-Community system Ej Private ❑ Depth to Water Table -------- ff. Character of soil to aepth of 3 feet: Sand E] Gravel E] Sandy L9am,0Cl,jy_Loam E] Clay ID Adobe El Hardpan El Previous Application Made: (if yes,date----------- No E] New Construction: Yes E&—No E] FHA/VA: Yes E] No[�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer_is availableL within 200 feet.) Septic ink: Distance from nearest welle�-- - ------'Distance from foundation__3 --------Material------------------------------------------...... No. of compartmerifs-,�9-----------------'Size---rA-Y;V4--------Liquid clepth---47/---------------Capacity,...14h 7.� Disposal Field: Distance from nearest well ......Distance from founclafion.-:3�0-------------Distance to nearest lo;line--- Number of lines---------------Z------------------Length of each 4 r line--------P-------------------Width-of french.____ A--------- Type of filter material--,j ?0 E_4 ---------Depth of filter'maferial----/?--------------Total 'length-------- ----------------------- Seepage Pit;' Distance to nearest.well-.A%aAt---------Distance from foundation.....14.-"--Distance to nearest lot line-----i$---------- Number of pits-------I—-----------Lining Size: Diameter__.__ r ----Depth_-.-_..}.___ __'__-_-_-_. 11----------------'Distdrice from foundation-------------- --------------------- Cesspool- Diitance fiorn neares we material------------ El slze: Diameter--------------I---------------------- ------------ Dept h---------------j -----------------------.-Liquid Capacity----------d -------gals. Privy: --------------- -------------- ----Distance from nearest building--------------- I Distance from,nearest'we ---------- ElDi�tante to nearest lot hrie--------------------------------------------- ---------------------- ----------t-------------------------- --------------------- -4 Remodeling and/or repairing fdescr;be):-------------------------------------------------------------------------------------------------- ------------------------------------------------ --------------------------------------------------------------- ---------------------------------------------•------------ ------------------------ ---- - ---------------- ------------------------------------------------------------------------------.......------------------------------------..-------------7---------:----------------------------------------------------------------------- ,I. I -if ---------------------------------------------:-----------------------------------------------------------------------------------------------------------------------------------------------------------------------:------ I hereby certify that I have prepared-f his'a0plication and fhat'the 'Work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ul ions of the San Joaquin Ldcal Health District. o wells, buildings, etc., can be placed on reverse side] r 4 (Signed)----------------- ------ --- ........ ------ -r and/or Contractor) ----- ....-- --- --------- ------ ---------- ----- -------- ------ --------------------------------------------- ---------------Owner By:._.. : I -- ------ -------------- ------------=--------------------------I-.........................(Title)----------------------------- ------- - ---------------------- (Plot plan, showing size of Illot, Iota n of system in relation + 7 FOR DEPARTMENT UtC0NL-Y—,,_ APPLICATION ACCEPTED BY— -------- -f------ -- --------------------------------- DATE------I--------- --- ---------- --------- REVIEWED BY-------------------) _ -------- 1- --- ------------------------------------------------------------------------------ DATE....--------•--------------------------------------------------------- I BUILDING PERMIT ISSUE---•--•--- ----------------------------------- --------------------- DATE-----------------------------------------------------•------ Alter tions .............AlterS+ionsand/or recd endations:-----,:----------------------- -------- ------- - --- --------- -- --/X------ ------- 9- ------------------------------- Ja-- t - -- ------ 4,(---------- - ------ --- --------------------------- -------------------------- --------- -- --------------- ------ ---- ------------ -- ----- ------ - ---------- 7------------------ A- -------------- ----------------- --------------------------------------- FINAL INSPECTION'-BY: - -------------- -- --------- ---- ------------- - Date------------� -—--------------�/ ---------------- 0 QESAN #Vq�JONN LOCAL LTH DISTRICT 130 South Arneritan Street 300 West Oak Street 124 Syi:Ornore Street 205 West 9th Street Stocktam,California Lodi,California MaMtOCOr California Tracy,California ES-9..-IBE-