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1FOR OFFICE USE: ................................_. . .................. APPLICATION FOR SANITATION PERMIT Permit No. ..... ...... ............ (Cemplets in Duplicate) Date Issued Z-11 - -IC This Permit Expires 1 Year From Date lswed Application is hereby made to the San Joaquin Local Health District for a permit to cons ct a install the work herein described. This application is made in compliance with County Ordinance No. 549. n , ��// JOB ADDRESS A LOCATION. 5 .._c:1L^_ !!....� .��!-/ - '- -- . ... .. Owner's Neme... .. ¢"(/'enc'ss.'r.•...................... ........_. Phone--__..--•---.__.._...... .lir -,r- �.._ ......... Address.. - - 7._7.. - - +.. gags .....--..... --..., Phone -....._.........---' Contractor's Name...... i4�srLL PJ. w.ese-- ---'- - ......_...-'---....10.................-. . Installation will serve: Residence E31, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other Number of Irving units: 7!=- Number of bedrooms'......y Number baths ..7... Lot size ... ---------_---------- s Water Supply: Public system ❑ Community system C3 Private Depth to Wafer Table . ._ t. Character of soil to a depth of 3 fees: Sand E] Gravel C] Sandy Loam Q Clay Loam (Clay Q Adobe❑ Hardpan ❑ Previous Application Made: (if yes,dcte....................) No ❑ New Construction: Yes ❑ No Q FHA/VA:Yes Q No❑ is TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool perm tied if public sewer is available within 200 feet.) , i 'i'll�._--_..ter Septic Distance from nearest well....> fl_......Distanc5e .fro foundation..._/..0...__.....f£4aterial._..u..rr.r��-.--.Fa---- uid . No. of compartments.(-- •••--f.-Llen�h each .�.-Liq 2_�epth_- d-of +ren h-Capacity �2.o.l,�._...(/�......K_O Dispo ield: Distance from nearest well..._ a.._...Distance from foundation...Jt1...1.......Distance to nearest of Number of lines..-..............._... 9IM i Type of filter material......tcS..R •----Depth of filter material.._..__/..-........Total length.....1�C.Lt_!.-.._---------_••—• i .._.....Distance to nearest lot line__.fe...�..::_ Seeps Pit: Distance to nearest well._-..�_n0....._.Distance from undation..-Ca_L „ = r .--..Size: Diameter........._...._.Depth......,-----.._.-_-..----- Cesspool: --- C -Number of pits:f{.....�_..-..__---Lining meterlal......t�. . - e r Cesspool: Distance from nearest well................Distance from foundation....................Lining material.............................gals.. j Q Size: Diiameter I.. '----------- ..............Depth---...........----- -- .._......... -.........Liquid Capacity............ ..._..gels. ( Privy: Distance from nearest well......................._........................Distance from nearest building.................................... r El Distance to nearest o+ ins........._---.--_---------' ...._.._.. ._........._..__.......... lags. , } 1 _...._._._............._._...._..__._.._..__.._..._._....__........_ Remodeling and/or repairing {desaibe):.........................:._................__....___..._....._. ....._---_........-._........._ ..._........................._-------.-.__...._..w.._-....._........__......__.....-.........-..._....__._.__................_ ._ ..._. ...._....._....:__...._ . __......-...... ........................_._........_.........._....._.............._......-----......_.._.................._._.........-- - - - - m i I hereby certify that I have prepared this application and that the work will th District. done in accordant;wish San Joaquin unty ordinances. State laws, and rules end regulations of the San Joaquin Local Health (Signed)-------- -------- --e._:.. _ .......-'.................._... and/or Contractor) By:--------a '^ !Y t..�_...._... --------......- ---.............'--'............... -----........, er.and/................... ..... 0 or) tC (Plot plan, showing size of lot, loce4ion of system in relation t wells, buildings, ate., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-- DATE_.. ...:1_..'�.f.•.----- ------ REVIEWEDBY..................-------_---- .---............................................................-.............. DATE.----_---...---••- _._-----_... BUILDINGPERMIT ISSUED...-......I.........----_----.._.......................—.....-..................-........ DATE.................._...-...................... -- Alterations and/or recommendationii."................._................................... ...-..--_..._..... __........._...._....__...........__...._.._...-_-gags. .._...---......._-....._....._.._..._..........._ _--.--_.-_-----_-...--_.......___ s ' ........... ------------.................................................................---------...._.-- 4 . FINAL INSPECTION BY: . : Date.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1 s01 E.Noaallon Ave. 300 West Oak Sir., 124 Symmore St,"t 305 Wesr 91h Street Stohlon,Califemia Lodi,California Manreca,Caliiornie Tracy,Califernie