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CATION FOR SANITATION PERMIT 3 <br /> �'�a►',:,.i Permit No. <br /> # (Complefe in Duplicate) , <br /> Date Issued <br /> ` n,P Application 4s ereby cne',� ro i'� ae,-si <br /> ;in q::'n Local Health District for a parmit to construct and install the work herein described. <br /> r This application is moor cn•1;.3ienea with r,ounty O I nonce No. <br /> zn a <br /> . 44. <br /> CATk7NJ08 ADDRESS P�JD ...... � <br /> �........ <br /> Owner's Name Ph � <br /> Addrec / . lSxs. <br /> .. <br /> L�,, r ....................... <br /> Contractor's Name..-y%=4•'. +.Y............_....--•---` .....................•--....-•--•----•--•.--..........---------.......................... Phone_...................:........:... <br /> , <br /> }r+ Installation will serve: Residen;e ❑ Apartment House ❑ Commereiet ❑ Trailer Court ❑ Motel ❑ Other [} <br /> Number of living units ........ Number of bedrooms Number of baths .-...... Lot size <br /> ........ ................ <br /> 'WOer Surply: Public syster, [3 Community system ❑ Private❑ Depth to Water Table ........ ft. '' <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑11 Adobe❑ Hardpan 0 l <br /> 1 ' <br /> Previous Application Made. Y&.% ❑ No❑ New Construction: Yes ❑ No ❑ <br /> d <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS: <br /> (No septic ,,. . or cesspoet pemitted if public sewer is dvallable within Zoo feet) + I <br /> Sod+ic ank: Distance from merest wall_ -... Distance from foundalion..._�....Material................. <br /> �' N ­; <br /> a. of compartmentL_......... Si26_. ._ 7. <br /> ...............Uquid.de�th...... .'."...Ca ci <br /> Dipqoy� <br /> Fil� Distance from nearest wr1{..- *_Distance from foundetion...� Distance to nearest 1i^ ~ <br /> _.. <br /> �i4 � umber of lines.- .._ -. Length of each line.-------.__-- ..Width of trench..- - <br /> f tt <br /> ype of filter materia! ...d►-!? dDepth of filter material-----.. Total length !?Q�.. <br /> c Seepage Pit: p `{ <br /> • ...... nearest lot line----....:.I'll <br /> N+umber of rest well...... LlninqmQate aance from found5'�ze'Qieme#er.. Distance toCesspool: Distance from nearest well.......... .—Distance from foundation.............._.._.LiningC 5'Ize: Diameter,.._ `, .Depth..W._......_.......•-•---.---_-..----------Liquid Capacity .W� aPriv •. ..Distance from nearest building--.---___Y• Distance from nearest well.........,-.---.........--••----._............- .. .........__..... ._,..Distance to nearest lot line....-----•- - .....- <br /> -- - -- _. <br /> ` Remod g and/ort repairing ( scribe):........ ••_ _ _ j <br /> .............. -,......_.. ,_ .------ ... .. . ]• �.1�' - <br /> I hereby oertify�that I beve prepared#6&Wmfflon a.-d*at f6 work wa be do"in accoirdanm`wft San Joaquin �. y y <br /> ordinances. State kws, and rules and reguir f6 San Joaquin Local Health Dirk+. <br /> : <br /> y:. ..f..- astd/or Contractor): <br /> E --...---.--�_.... ..�_. .... �....:.... ..:.... {Title). ......:..._... <br /> .._....---•-• --_-- <br /> tng si:a of lot location of <br /> (Plot plan, show system in relation to wells; buildi <br /> .# n9s+ etc.. can be placaci on rirerse <br /> ',F k FOR DEPARTMEN'i JSE ONLY } <br /> r.PPLICATI:7�N ACCEPTED BY.... v �--' <br /> - --------------------------.-. ----- - <br /> ..... DATE. <br /> REVIEWED dY...............--•........ ....... ..... <br /> ..... .............. ••-_----..... <br /> BUILDING PERMIT ISSUED................. <br /> ••-•--------••-..- DATE. -•. <br /> ,y Alterations and/or recommendations:............ <br /> _ _.-........--• --••• - <br /> A. <br /> h ........................................................................ _....`.. <br /> ............ ........._-....- -.._..----...------..-.--._..:.-.........--....._..._--............., <br /> ........... ..... .. —.... <br /> ....... .—........... .. <br /> a <br /> I <br /> ............................. — , <br /> .. .............. <br /> I r!f1P,L INSPECTION BY:..-...---.- � I�/�'�fr �r <br /> tL-.'..-�:-........ .... ........................ Date..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> i <br /> 11D South American Street 300 West Oak Street 132 Sycamore Street x$14 NvIS—C. 5fteat <br /> `.r•oc►ian, CaliForr:ia Lodi, California MaMeea, California <br /> Trwy,C&"X%a <br /> y i.o.i:cd W-z,ao f' <br />