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APPLICATION FOR SANITATION PERMIT V Permit No. .. � =5 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to comtrujt an j install this s-w•o kk hryta�in described. The epplit etion is made in compliance with C jnty Ordinance No. 549. �[s.r- (ZCAZ-- C' JOB ADDRESS AN6a.��C9A7TION...r"'�h� � rYk. 1...... L� .o ...... .As ............... _.. Phone .............. ._. Owners Name.. L .............................. - Contractor's Name... c .c ...... ......: c .................... _ ...._.. Installation will serve: Residence [B<Apartmeni House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - g .... ........... Number of Irvin units: ..... Number of bedrooms..: Number of baths ..I... Lot size .... 2.t t•L�..--•••---•-•�- Water Supply: Public system ❑ Community system ❑ Private [a-Bepth to Water Table ....... ft. Character of soil to a depth of 3 feet: Send❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe[aYlaircipen❑ Previous Application Made: Yes ❑ No B_�New Construction: Yes LGKNNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifF sewer is availaLls within 200 feat.)�� \� �Sailtic ank:9 Distance from nearest waP 0.' Distan from foundation_iddept�-MeteriaL. •�d.'sK:...... ........./ 11 54-.S-�. No. of compartments.. 5za..+5..lY.�� -."..Liquid depth 6.r ��. .._..... Cepacify.,/....f. . Disposal Held: Distance from neere t weJ Ups enc rom ou etion.... 0_..Defence To nearest lot line...............5: C / Number of lines...... - , _ Length of each Iino...Lr1.a -y Width of french..e?,,. .................... W Type of filter material..e L�" l) ..Depth of filter material..../_..(� . . .Total length........ .Ct.................. Seepage Pit: Distance to nearest wa'I .. .....Distance from foundation................ .Distance to nearest lot line. ............._ ❑ Number of pits...... _ . _ Lining material....._._..__Size; Diameter_._......__ . ._... Depth................................. . _ _ . Cesspool: Distance from nearest walL.__... .. Distance from foundation. ... ......... .. Lining material........_............_.......... .S' ❑ Size: Diameter..... .. .. Depth...- ..__ ...__. ._. .. ........ ....Liquid Capacity.. .........................gals. Privy: Distance from nearest well .. ... __...._ .Distance from nearest building ......................... .... ❑ Distance to nearest lot line. ..... ....._... ............................I................I...... ...... Remodeling end/or repairing (describe):._..... ....... . .. ___. .............................._............................._..............__..........._....__......._f. ..........._.-__._......._......................................................_. . ......_._._.............................................-.............. ..._.....--'-".................._....._........._...................._........_-.._.. ..................... : hereby certify that I have prepared this application and That the work will be done in accordance with San Joaquin County Ordinances. State laws, and rules and regulations of the Sen Joaquin Local Health District. ♦Oaxnsu� (Signed)......._ _.. ._. _ . .. . . e Contractor C BY:__................._............ . ._.. ... . L. f...C ....... or. (Plot plan, showing situ of lot, location of system in rale i n,to wells, buildin s, etc., can be placed on reverse side).--- — FOR DEPARTMENT USE ONLY APPLIC,\TION ACCEPTED BY .ti. {:,,y.=....._ _....._..._ .___. _ ^ATE..... .. ,y- ,....{....f-......__.... c , _ .._ ........................ DATE BY._ . .._ BUILDING PERMIT ISSUED.........__ . DATE. _ .. ........ Alterations and/or recommendations: """ """"' ""' ' .. 'N� �-..J. Ct ... . ..... ............ ................ ....._ ._. ................ -. . . ..................... ......_.... __. . ..._. .. . . . ___ _. . . . ... _.. _.__. . --............. _. ........ ................. ............... .... ... .......... . ! FINIAL INSPECTION BY: i.. _. Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 170 South Ainri�un $bur 1c0 Wot Od 51'.0 171 $Vumon Shoo 214 NoNh ••C••Stnwf Stndto., GCfomu Lodi, C.41010in Mnnbu, CJitornin TucY, Cdilornin