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FOR OFFIC USE: <br /> ..............r/--- <br /> 'C�%A <br /> Permit No. Zle"I <br /> .......................... ...................... APPLICATION FOW SANITATION PERMIT <br /> ...... -- ---- <br /> ..................................................... (Complete in Duplicate) <br /> Date Issued C 3 <br /> ------------- ................_. .......... . This Permit Expires I Year From Dare 121.190 <br /> This application is made in compji.ajj`Ce to di01arl I�;A <br /> Application is hereby made to the Son'Joaquin Local Health District for a permit construct and in %Uh-!d&,ibed. <br /> 5with County Ordinance No. 549. <br /> A <br /> 0�� V <br /> Nai <br /> JOB ADDRESS AND LOCATIO <br /> .................. <br /> Owner's ........ ... .... Phone.._........-------.............. <br /> 2 Address.....0 ..........1�.- . ............. <br /> ----------- .......... -­------ <br /> Contractor's Name........................ - ---------------- <br /> v <br /> Installation will Zama.- I Residence X Apartment House ❑ Commercial Ej� Trailer Court 0 Motel 0 Other C] <br /> t 1 11 —1 -1'- . . <br /> Number of living un.iini; Number�ofbedrooms .,74 ,,.Num6er of baths .7.. Lot size- ....................... <br /> Water Supply:I <br /> Publiclsystem 0 Co`-km6nit Ej Private J�' Depth to Water Table&_O. ff. <br /> I '�,.4 1 1 <br /> I y❑system <br /> ficn'_-'Yesj4' No El <br /> Character of foil +a a depth of 3 fee: Sand 0 Gravel [I Sa�dy.Loam L3 �Qay Loarn� Adobe 0 Hardpan C] <br /> Previous Application Made.�' (If yes,da a--------- ....... No E] New Construc FHA/VA: Yes 0 No El <br /> TYPE OF INSTALLATION!,AND'SPEC FICATIONS: <br /> (No septic tank or cesspool.permifted if public sewer is available within 200 feet.) <br /> • <br /> Distance from nearest well.4.4.1.....Distanc� from foundafion../,,Q............Mo!2;i4 <br /> Septic Tank: 7 <br /> apaci <br /> c <br /> N ompartr I compartments.._-c: ................ ep. . ......... <br /> If well-k.0........Distance from flunitio,,�.p .........Distance to nearest lot line.._._..-._S <br /> Disposal Field' Disth nj from near, <br /> Nuiiilo of Length-of Lath iin4igb.�.....4 ......Width of trench---------- <br /> . <br /> -Type �4jteral <br /> iilter mi <br /> / , I Depth..of.fi.1fer;material---IR•-----------Total lengih....../_T-#P .... <br /> Seepage P5 <br /> Distanceto nearest well.140.0_:........Di,fance4rom foundlatiorinearest lot line.....�r....... <br /> Numbers !;c;�,r )Y_0 %� Distance to iiV #?ruc <br /> . of pits_ ...........Lining material. .1 -_--.Size: Di,m, F� <br /> C2S!PoqI: Disian <br /> from nearest well......... Distanco"fro. Lining rnata`ri3O[!.'.:!�_' ------------­*----- <br /> 71 <br /> ❑ jr Size: Dianneter-.7--- _-- --—_ ...�*6,-pihl------- ..LiTuid bapac'ltyL-"........... ............galnA <br /> - <br /> Privy: r4arest well....-.._................... ..........Distance from nearest buildin .... <br /> ril Distance from <br /> 13 r Distance to nea're'st lot line-----.................................... <br /> .................... ------------------------------- <br /> Remodeling Ind/or repairing (describe):........ ............ . -------I......................... <br /> ...... #-�-------------------- -- <br /> - <br /> .................... ........... ...... q- _---------------- - <br /> ................ ..........__7................----------- <br /> • <br /> - <br /> .... ..............­_­ ................ ........... ------------------------------...... ................ ................. <br /> ................ ...................................­­1--------------- ...................................­­.... -.....------ --- ..................... <br /> Iher <br /> b,­certify that I have predared this application and that the work will be done in accordance with San Joaquin County <br /> ardlirmr,g, t laws-, and rules and regulations of the San Joaquin Local Health District. <br /> (Sig ee 4........: ..s-. .. ... <br /> ---TA . ............... ... ------- - ------------------------------------.................._...(Owner and/or Contracf6r) <br /> -.CST--------- .......... .... ........ <br /> By!........_.......m...................... ............................(rifle) e3lr_ <br /> ocation a system in role wells, buildings, etc., can be placed an reverse side). <br /> (Plot plan.showing size of.lot. I n f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... ....... <br /> ....................... S1___ -- .. <br /> I----- -- . .........................I.......­ .. <br /> ....... ......... DATF___. -----------................ <br /> REVIEWED BY._....... <br /> .......... -----------------­----­-­---- ............................... DATE_..---------.....................-._...•------- ..............BUILDING PERMIT ISSUED-.------...-----. . - ..........­�.................. ...... DATE..---. . ---....-----..-..------------------••- <br /> M' <br /> Alterations and/or reco mendaflonsi-_........._--------I..........r­............................................................ ...........­­....................... <br /> ---------- --- ..................................................­1...... <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------­---------1.......... ..--­---------------------- .......­................•.................................. ­ ------------ ------------------------------ ........ <br /> ............... .......4........................................ ..........................­ .................................................................. ................................ <br /> ..........I........... ........................... ........... ................................................. ....................._....................... ........................I'll------ <br /> .7 <br /> PA <br /> FINAL INSPECTION Bi...A/; ... .............. Date....._72..... .................... ........................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha..O..Mi. 300 W..,Oak Street 124 Sy,.rn.n,5fr.f 205 W..,916 Area, <br /> Sfo,ckn.,California Lodi,California Mani.,.,California Tracy,Collf*rnio <br />