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.-- ------------------------------------ ----------------- -- F/f P '7�? 7 - "- ., ---------------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- ----------------- -- --- (Complete in Duplicate) --------------------------------------------------------- This. Permit Expires I Year From )ate,Issued Date Issued Application is hereby made to the San Joaquin Local Health Distric 03 0- t for a Permit to construct and install the work coerein described, This application is made in 0 pjla�ce With County Ordinance No. 549. 1PI JOB ADDRESS AND -L Z A: Owner's Name------------ Ray------- ---------- -4-a-&-M-------- ----------- --- -- ---- ----- Phone------- _0----------BOX--------2y ------ESC e -c ------------ -- --------- ---------------------------- Address P� -----O- -------------------------------------------------------------------------- Contractor's NameWtsf.-F-K----------------------------------------J---------------- -----------------------------1--- --------- ------- Phone...... Installation will serve: Residencee�Apartment House 0 Commercial E] Trailer Court E] Motel ❑ Other Ej Number*of living J---- Number of bedrooms -3- Number of baths Lot size 2-00 �un.i f s,.: Water Supply: Public sysfe m. ------------------ ---------------- 4� Community system ❑FI/Private, (Depth to Water Table Character of soil to-kdepth of 3 feet: Sand ED Gravel E] Sandy Loom E] Clay Loam P-lClay [I Adobe Ll Hardpan Previous Applicati Made: (if yes,date_____________-------) ❑No ?7�' New Construction: Yes [�]�No El FHA/VA: Yes [�- No E] TYPE OF INSTALLAT'IO' N AND SPECIFICATIONS: '- - (No-septic tank`-,or cesspool-perrnitfpd-if-pu61ic sewer-is-availa6le-within-200:fe6f) Septic nk: Drstanee from nes• ---Distance from foundafi6n /O.-------- Ma�erial No. bf compartmenrs --------- 7------- ----- ----- _S�ze-�1XV-X-!�=Liquid depth.- Z— Capacity--- Disposal Field. Distance from nearest well ....D;stance from foundation--_I--- ------- �Umbd 6f lines-1-j-0/ - 1 1.1 < ---------_---_--..Distance to nearest lot lin,,-,-577-- I -- -------------------------Length of each line--------?a---r Width of trench--- Typewf fiifer maie�ik---RQCK,---Depth of filter material------1------- Total length---------------- ----------- Seepage Pit.' Dist to neai1rA1'jw,Ij ------------------ Seepage -------Distance from foundaf�,,----/69--------Distanc f NI -I'- '%S i fM L-:?,-� e -- ---------- umber.of if -, ... _5 o nearest lot iine--..�� Lining ma fe ria Size: biarne-f,,--�'A-7S------Depth--Pw --2—- Cesspool: ance, eair --------77--Disfance from founclaf �Cmaterial__- -4- ---------- :�-- -------- ro n UL we, ion---- Lrl r ' -------rLining material---- ;a ete --- - ----- ------------ ---------..Depth--- --------------------- tj ---------Delpfh--- -------------------------------------------------Liquid Capacity----------------------------gals. A Privy- Distance from ned ell -------------------- builclirig--�j__-.____Distance from nearest El Disfance to near S ' t kne-----------11 e ------------------ ------------ ------ --------------------------------------------------- --------------------------I------------- ----------- --------I------------------------------------------------------- --------------------------------------------- -- ------------ - -Remodeling an d/or repairing ril 'e).--. — (desc --- - -------- _�j ---------- .,i- ------------- --- --------------(------------------ -------------------------------------------------- ------------------------------------------------------------ -------------- ------- --------------------- ----------- ---------------------t--------------------x--------------------------------------------------......---------I- --------------------------------- ---------------------- ------- -- ---------- rje( -------0------------------------------------------------------------------------ 37 I hereby cerfif�-�th'al,--.I have prep'lidd this application and that the work ordinances, State Iaw's'1--� j_ . lat.0 S of t e Si will be done in accordance with San Joaquin Cour ,and rules andife1guiatiO S of f e San Joaquin Local Health District. fY (Signed)- -Y --- ----------------------------- ------------ -------------------------- 44�1� 01 ----------(Owner and/or Contractor) By:-------- --------- .. -% -------------------- --------------------- --------- ------- (Title)------------------ (Plot plan, showing size of h ----------- --- --------- of, loca+ion:of system in relation to wells, buildings, etc., can be placed c--n reverse side). FOR DEPARTMENT USE ONLY*, APPLICATION ACCEPTED BY-- --• ----------------------------- ------------------------------- REVIEWED BY --------- DATE----- ----------------------- _ -' 1--------t---------------------------------------------------------------- DATE------- BUILDING PERMIT iSSUED I --- ------------------------------------------- �a,-I---------------------------------------------------------------------------------- DATE------ -- ------------------ Alterations and/or recommenclaf ions:----------- ------------------------------------ ----------------------- I L. -- — V ------------------------- FOR DEPARTMENT BY- -----7 7 �5?t K" ------------------------------------------------------------------------------------------------- ------------------------------------------------------- ----------------------------------------------s -1---- ----------------- -- ------- -------------------------------------------------------------------------I---------- -------------------- ---------- -----------------------------I...... -------- -- ------------------ ------ --- - ---------------- ---------------------- ------ -------------------- -------- ------------ --------------------- -------------------- --------------------- - - ------ ----- ---------------- - --- ---- ---- ---------- -------------------I------- ------------------------ ----------------------------------- RNAL-, SPECTION BY:. - - --------- --- ---- -- - Date------- ---------- ---- ------ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hurellon Ave. 300 Wes)Oak Street724 Sycamore Street 205 West 91'h Street Stachion,California I Lodi,California Manteca, California Tracy,California F.R.Ca.