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APPLICATION FOR SANITATION PERMIT Permit No �J � (Complete in Dupgcate) Date.Issued 1�_3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described., ' - This application is made In compliance with County fOrdinance No. 5449. JOB ADDRESS AND C/1TION. .. . rt"uacif.. L[!14�ift..J./ ../.7..�.._ �.0- /.(.'J.. cal UFY ..._ /�- 'r"�"'� �p ' q/�/p Phone Owner's NeESS .NDfl..1.... ................................................................,GO f Cddress onus.or's N�.�.....�...... ... r..�.d. 1. . .................. ........_................................._one...................... i £t Contractor's P eine ... Ph 4. Installation will serve. Residenc� .Avartm�nuse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ak Number of living units: ...1--- Numoir of bedls.oms...aIn Number of baths.../... Lot size .1ILen.7.X..S�0... -Water Supply: Public system ❑' Community sye.'em ❑ Private Depth to Wafer Table`v. ft. Character of sail to a depth of 3 feet: Send❑ Gravel❑ S3ndy Loam❑ Clay Loam❑ Claypr Adobe❑ Hardpan❑ Previous Application Made. Yes❑ No YP ' New Construction: Yes KL No ❑ A. TYPE OF INSTALLATION AND SPECIFICATIONS: (No wp0c tank or coupool parmiffed if publicsewer is avuBable within 400 feet.) Ls ..Dista fr m fours tlon....�s. .Mater) a Sep}IS Tank: Distance from nearest welL �1. �t�a is s Yttt( No. of compartments .. ,5, .Liquid depth .:.Cepacify p y � . .. Disposal Feld: Distance from nearest well 4�PQ Distance from foundation .�..�........Distance to nearest lot I Length of each line til Width of trench. A... Number of lines 9 r .j Depth of filter material'".....�. .Total length.....: Typn of filter metenal �� .., Seepage PI+: Distance to.nearest well _.Distance from foundation....................- Distance to.nearest lot Ilne ' .. F1Number of pits .........Lining material..............._....:Size Diameter ... Depth F Cesspool: Distance from nearest well.................Distance from foundation. Lining material... . .:...:.......... . ..........Depth................................ ........ ..Liquid Capacity_.: . . . .._..gels. � Size: Diemetec.... Privy: Distance tram nearest well. Distance from nearest building El Distance to nearest lot line.` Remodeling and/ r repaving Idescribe( f.Y �s' vf1 "" _l.V....�. �•�s'.'z+s3dS.fCG�_ p C 1 Q I hereb tfy-that I have prerparecl rs applicatfon and that the work will be done in accordance with San Joaquin Courdy _ ?I • . . ........_ . District. �I�<, p ordinances Cafe.lar" a �ules and regulations of the Sen Joaquin Local Health fl Signadj......... .. �..Z4. �1 1...... . _ I .... O( wns r and actor /« Contr By ..... . ..... .... . ...... mt e)...................................... d (Plot plan showing srta of lot location of system in relation to wells, buildings, eta, can be placed en reverse side). . . ., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ...... DATE... - " REVIEWED BY........ ... ..... DATE... I�, �I C;V r, x" BUILDING PERMIT ISSUED.._...........'.. ......... ::.:........ DATE...... . ....... ......_........ ....... '. "rations and/" recommendationst..........._ ...... .............................._.................................................................................::...:::........... ' t ........................................_................................................................................:....__...._...... . ...................................... __ ............................................................................... ..............................__.................:.:........_ i ..... .. ......_............................ . . .. ......... _ : !-� S� ' FINAL INSPECTION BYDate. ... . ...... �. .... ...... ... ......_. .. JOAQUIN LOCAL HEALTH DISTRICT f5 Iso SovM A,naricae Shoal 300 Wnt Oak Street 73 Sycamore St.0 114 North "C"Sh«t �"- stocktea, C*Vforn9 Lodi, Camamia Manta<a, CJlfornia Tracy. California .}.: 1052 Rav7ud W3100