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FOR OFFICE USE, _----_---------------__...---.--...-----..- APPLICATION FOR SANITATION PERMIT Permit No. ..�P.-.1.L?1F../- .--------------- - --------------------- -- (Complete in Duphoate) /v� S Date Issued _...-_..__...-....... _ ...----------.------------ This Permit Expires 1 Year From Date Issued ©!ft - f c£D-Cff Application is hereby made to the Sen Joaquin Local Health District for a permit to ruct„endrnstall the work herein described. This application is made in compliance with CountyOrdinance No. 549. -9��F �S L.to cl l s JOB ADDRESS AND LOCATION.- -...--. . v I% ... .._. a!�-ISSX f............._—...........-. s /'/ - -- - �j .� ------- - 01 Owner's Na e.----' - -' -- ' --'-----`�--R!�yiL'-Y.L. ..e. ---. Phone-----------• -----------------------------'--'-- ---------- -•----------- Address- 7../............. - Contractor's Name.------ - - ---- r----- -`- -- . .- - .-...--"----------_-_---------------. Phone.__............._.. s� Installation will some: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -`_�..-- Number of bedrooms ....V.... Number �aths �.--- Lot size ........... .. . - ..-.----_I Water Supply: Public system ❑ Community system [IPrivate Depth Water Table ._.__. ft. {V Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam relay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date._................ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feef.) v a �� Septic ank: Distance from nearest well...IA _.Distencs from foundation_-__.._.f-.,O..--.MateSiel__..L:efC!'*:¢n •.....-.._ No. of compartments Size p /t i ,p P 2------- -- ��X'1--�-�..-eS.�Llgwddepth--'---'----/-'-"---_Capaaty-- Dispos Field: Distance from nearest Distance from foundation..-/.&.-'-_.-_Distance to nearest lot line_5L. -.-- Number of lines----------- ` - Length of each line-----8Q_Z.__._......Width,of trench._..-2-l....... Type of filter material._-.. _-..--Depth of filter material..-. _.__Tofial length...___D-:------------ _.........1 r -. s Seepage Pit: Distance to nearest well......................Distance from foundation............._.....Distance to nearest lot line.......y......."t i ❑ Number of pits.......----_---- ...Lining material.......................Size: Diameter.......................Depth..........._..-.-..-._...--..._:. i!J Cesspool: Distance from nearest well.................Distance from foundation------------------Lining material__.-_._................._.--...... Size: Diameter---'-.........'--.-'------------......Depth......................»-..---- -----------Liquid Ca aci als. rs Privy: Distance from nearest well-------------------L- .____-Distance from nearest building_................_..-.--_...._`:_. ar ❑ Distance to nearest lot line...............................E-..-..--..-------------------------------------------------------`-----------------------'-". -�-... :, 1 Remodeling and/or repairing (describe):.................. ....... .......--....._ __.-----------------'.........................................---.._.---'---'--••--`------- --.....---------------------...............-................................................... .............................. , .............................. -------'----------'--------”- ------------ ---------------------....__.._._._.. -*.:- 1 hereby ce dY th f I have prepared this application and that the work will be done in accordance with San Joaquin Count' (� ordinances, Ste law , nd rules and regulation' the San Joaquin Local Health District. � (SignedBY:.... .......------------'-••�------tf -.---._-`-.._� -�""� a ----(rifle)--- d--- Contract (Plot plan, sho g size of [at, location of system In relation to w , buildings, etc-, can be placed on reverse side). T -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ /.. DATE.2-»-2d.. -_ ..-.--_..--............. REVIEWEDBY................... -------- --------- -- ------------------------ .... DATE........... '---"-'-----._...-..-'---------" BUILDING PERMIT ISSUED........_.`.! f ...........'---'---. DATE and/or recommendations............................-------------.... - - _---_-__.........__..._...------------ --------_-_---------- " --'- --'--..-....._....... ................ -........--...............-----'-----------------.................................. ----------------..-.-.---- ---------------------------------------------------------------- ._0 - ----------------------------- ....-.. •---................................................... --- ........ _................................................................. ......... ---- ---- ----- ........... ------------------ ---- .............................. �.s� FINAL INSPECTION BY:.alrl-.'°lHi !L!/. l�L-....__.._.____ Date-_ ............_........................_._ ---------'............-........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street steckloa,colifornla Lodi,California Mamsm,Ccnfornio Tracy,California F6 9 RFVISEa 0-69