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j FOR OFFICE USE: f APPLICATION -FOR ,SANITATION PERMIT Permit No _ ....... v -------- ---------------- ------------------ (Complete in Duplicate) I- � ' � � � . Date -Issued•.�'�....---�#-w ____.__,;,,............. ......................... This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin-Local Health District for a permit to construct n Install the work herein descrbed. This application is made in compliance with County Ordinance No,,549. 0 — ! /�^c �l Ll�}�HCl. JOB ADDRESS AND LOCATION - ..MQl �--- hQ± _F....../Yl_...fL. f ..... Owner's Name._.------ E :. .. .......... .. ------ Phone------------------••-••--•----•.... -----....-- •----------------Address. 1 C Contractor's .Name-----.:?.O.-Waha`K-------------------•---------- ----------------------------------------------------------------------- Phone---------------------------------- Installation w11l,serve:£l,Residence��,,., part'merit Houlle.,H Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of41i nt�-nits __ . _ NrJ+rnbel of bedrooms 2 umbe f„ a s_ ,Lott size ... � ................:... Water Supply: Public system Ell'1Commuli Ste '�' Privateer Depth—Fo IN ter fable ft. �Y. Character of soil to a depth of 3 feet: nd Gravel ❑ Sandy Loam ❑ Clay LaA ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made If yes;d -.-- ._ ..-..-_} No �ew Construction; YsNo ❑ FHA/VA: Yes [3No 0�. TYP'E_OF�INSTALLATION_AND.SPECIFICATIONS: ,3'"'�'(No septic tank or pom ool pea e'sitwell_phc sewerDista aeafromlefot redo?o�feet!) __------ is ____Mater a tr Septic Tank: s I [� No. of compartments----- -- -- -Liquid h pth� Disposal Field: Distance from near dst Z111�__--�__-Distance from foundation___ P. .....Distance to neardst lot line�.S......... j 1. Number of lines__________ ___ '_"�� '�Lt}��h#of each Ilne________ �� Width of trenchf�.__��?... I YP Ip 9 �- - 9. - Seepage Pit: Distance to nearest ell______________________Di sante from.foundation-..-____- � Total' length....-_�'`_��............_,_.:____ Type offilter materthl._ _ _/"�__De Depth of filter material______,/_ _ x ,, 1-1--- est lot line------------------ ---------- El -------------•- Qistance to near r [] Number of pits--•------------------Lining material._---- -_-- ----------Size: Dia meter----------___--_-- Deptf,----------- __-- 4 .._..__----__..r_ . �. 64sspool: Distance from nearest well------------------Distance;`from foundation._.__- - Lining material-------------------------------- -------------------- Size: Diameter--------- ----------De th_..I--------------_---- l--- ----Li Liquid Ca aci els. _ ❑ ---------- -• -- p Distance fr 9 #� ty==;:•r�-- -- -•-•�-----' Privy: Distance from near well_____________________;____---- --- m nearest building---._.: ________________.__. --------- Distance to nearest �o -li ---- -------------- ------ •--------------- -- n----•------ Remodeling and/or repail ing'(desc�r ilae) k =`----- � ,. � = -....-..-..»------------------------- -----------------------------`•--------- _ ------- ........... w , -, ., -�+ ,yam y - -------------------------------------------- . 7: . --------------- -------------------------------------------------------- Ft_.. ------------ I ---- k I hereby'cirtify that I have`p pared this application and that the°work will be done in accordance with`San" Joaquin Couh ,ordinAnces,--Sfafe and 'r"ules and regulations bf the San Joaquin Local Health "District. Si ned -------- ---- -A------------ --'--. ---------.---'------------ = -----------------------(Owner`+and/or Contractor) .. 9JJ �-"-^". - lay...... - `�- ----------(Title}------------ .— —_._-..... (Plot plan. showin4 size of lot, locatlon of system in relation to,wells,+tbuildings, etc., can be placed r;n reverse side. t F.QR "DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- ------------------ DATE-------- REVIEWED BY--------------------------------- - .. r r i All----------- ------- a; },DATE;6,� ;� ' .............. .................-_ BUILDING PERMIT ISSUED-----:=:= -------------- ------- --- - --------------` DANE. •------ :=................ I Alterations and/or eco mendat' ns:==' :..::' - ---------------------------- T • �: Nv>� i . --- - L � !� E ) -rel ----------------- ----- -- ----------- ...:_:_ . - ,77-------------- FINAL'r[NSPECTION :BDate--- - - - --- - . .... --------------------'._.._ .. SAN JOAQU:IN LOCAL HEALTH DISTRICT 130 South American street. 300 West Oak Street 124'`Sycamora Street 205 West 9th street Stoekton ;California ' Lodi,California Monte California-' Tracy;California ES 11 REVISED $,�9 8M 8.61 ATLAS " r