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Permit No <br /> E ' APPLICATION FOR SANITATION.PERMIT <br /> . . G �.5. is�'=r. :.... (Complete In Dnplioah) Deli Issued <br /> his r from Date Issued .. <br /> Application is hereby made to the Sen Joaquin Local Health DistriO for a permitto construct and instep the WoA h"n desceibed <br /> Thi; opplication is made in compliance with County Ordinance No. 549, <br /> lOII-ADDRESS AND LOCATION.. .,���o C���zrr C.,IU,� ,B.wc� ...... <br /> sPo .a1. .... ..�a�4lR. .. ' Phone Y....{8 ," : <br /> Owner 'Name. .. ..�// qq . �; <br /> Address........._...-............./ 33.L... �lr ..�i.�i.!'cK,Ri .. ............:... ........ .......... <br /> Contractor's Name.......................... s .1.f f.g� "....�Qn:�......................................................::., <br /> Installation will serve: Residence 4KApertment House [3Commercial [J Trailer Court [J- Motel 0 Other,(] #T .. <br /> Number of living units: _4 Number of bedrooms.a, Number of baths/'Lot sin <br /> j <br /> Wntor Supply: Public system.Community system ❑ Private[] Dapth.to Water Table./Xft M yt x <br /> Character of ml to a depth of 3 feet: Sand E3 Gravel Sandy Loom 13 Clay Loam Clay❑ Adobe 4or4pars❑ ' 'r ' <br /> Previous Application Made; (If yes,dote....................I No❑ , Now Construction: Yes o© FHA/V�u:Yea Q No❑ u-r <; w <br /> TYPE OF INSTALLATION AND SPECIRCATIONS: <br /> .. y <br /> (No septic tank or amapoa pernsiHed blic sewer h evailabla within 200 <br /> S�ptic T Distance from nearest well Distance rfyn f n iori.:fiQ..........M <br /> No. of'compartments.... SiLiquid depth...,�el.�... :Capacity <br /> ... <br /> Disposal Id: Distance from nearest well��,r.!Distance from foundetion.�.lt�....j..Dittance to nearest W. <br /> Number of lines.....pl ... . . Length of Tech lingf�?.... �Q...:.Width of trench <br /> Type of filter material..a !. iR. Depth of filter materiel..�.... :.Total length.. .: x <br /> E. .• .......�.. rS A <br /> Seepage Pit: Distance to nearest well.....:...............Distance from foundation.:...»..........Distance to nearost,lot line. »* lsa <br /> ❑ Number of pits.. .............Lining:materiel .....Size: Diameter.............. ':Depth t <br /> Cesspool:' Distance from nearest well.......:.:.......Distance-from foundation............... Llni material ' <br /> Size: Diameter.....:..................... Depth Liquid Capacity <br /> ... <br /> Privy; Distance Distance from neeres+well....... ... Distance from nearest building <br /> Distance to nearest'lot line.... .... ........ -- <br /> ' Remodeling and/or :repairing describeh �• ; <br /> } .lst.a�j.. us.k�c.c.s.�d..:. ..: ....:�:n..:. <br /> y ..!��S.r.. ..A................• •••.•.......... .... -- ----... ........ ..••. __ • r.Srr.� �.• �.• 1!h `k <br /> 11. •.............................................................-...................r..........................................................................• ....••.. ...... ..: <br /> ]' l hereb eMfy-that I have pre this application en that the work will be done in accordance with San Joaquisi Coin <br /> t ordinances, t laws, rid !alas egulations the Ss quip 1 Health District. <br /> (Signed... . ... <br /> ................: end/or Confle �+ ` <br /> By:..:......:..:.............................................. .. cel . ;x <br /> ' (Plot plan,showing size of lot,to Asm of sys a!platten to walh, trigs, etc.. Wirt be placed an rererse>slde���ry: .. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.....:t...... <br /> a' .............. k.. .................................... DATE.1 <br /> REVIEWED 'BY. r- DATE <br /> k <br /> BUILDING PERMIT ISSUED..................•. ........................._ <br /> Alterations and/or recamn:endations:.4p=,l.Q. !t��//duri�./.�......... <br /> 1y' ... (�t.' '.00!��M1l�3 ...1 - 1 "�.yAo ��..t`:.�. :.... �. <br /> ...A.A.. ''......V%Jr......�y......11:15`�G. C.�..i.......&'.X......yy ....ir4..�->tn�. ...�=YIR��.... & y ! - <br /> LSJC1�.-t�......�yU`jrlk .. ..D.{t�.... q` ,n,� .. Q .. ...�T. ►a.4.�,.__.... -p�VVV........ .i+�a�1rX....4 k1 76�Pi./R�+� h. <br /> ...................... .. 1s.e.�. r•,. ... �_a <br /> ­:!J--'_-;5'-30:5.........C.�.4�....:�rno�sar�.....[�.�.,.-.. .. � :. �'x <br /> t <br /> �. <br /> OL ,1 t h$4 _ ` (fly..\SS•K i . .��YC� '�,�{.„. :-T i �.� - <br /> ; 1NAL INSPECTION BY:.. .�'.::. ? �' Date.......` =.°..�..-. ..~..� �; <br /> 4p <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soulh Am.rl,an shell '300 West Oak Street 1=4 fytalriohl ffraN 20i W.,M ftraer, <br /> sir"klpn,California - Lodi.Cellfe►ela Jrlantaa,.cellr.rrrla TIS*,�,CINpp)• . V '� i+c i�., <br /> .� ,.t.I:.FA b SY iM x•61 ArLAH �•� I£'��'t��. <br /> • ' ... '� � � 'Ilk.;r;*""C-�*�!.: <br />