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FOR OFFICE USE, 7"o APPLICATION FOR SANITATION PERMIT Permit No. ...............-....... (Complete In Duplicate) Data Issued Application is hereby made to the yon Joaquin local Ilenith Ditlrlct for it per►nil In construct and Install the wort Wain described, This application is made in compliance with County Ordinance No. 549. 7 JOB AUDRESS AND LOCATION—./.'� •t•�:r , 4,JuaMra. r'6 Of Owner's Name ......�1! ..........» ......,.. Address .. .. . . . ........... . .... ......................... `('..�i►t'!................ ......»......... d ..Contractor's Name ,S�,�'....... Phone................................- Insldlletlen will serval Ilasld ace Aharlmenl sinus• C'J Cemmaralal ❑ Trallat Court ❑ Me1e1 ❑ Other ❑ Number of livinq umIll! Number of blidt brill Numb4t of balhf Lot Will Private i r .. Water Supply: Public system ❑ Community systep+ ❑ P ❑ Depth to Water Table ft Cherecter of roil to a depth of I leaf• Send[Gravel C] Sandy Loam❑ Clay loom[3Clay C) Adobe❑ Herd,sen C3 r„ Previous Application Made: Ili yes,dote I No ❑ New Construction: Yes ❑ No ❑ FHA/VA, Yes[:] No E3 TYPE OF INSTALLATION AND SPECIFICATIONSt (Ne wptic lank or asst 4 permitted If publla fewer Is ave11e44 wlfhln 200 INR) �+ Septic k: Distance from nearest well ICV Y Distance from ioundetion. 0". .. Materiel (,r�•t.�.t-� ..-................... e �1.�.•... No. of compartments Z- Site..t!!... . ... . ...........Liquid depth Cpeci .As2ty.. Disposal Field: Distance from nearest well !L't'f Distance from foundation...94)r....... .Distance to nearest lot 611411 ......... .. (� Number of Imes.. . �. A ' Length of each line. 7^. �.. . . .Width of french. .�..::::;.. : ' f Type of filter materiel 11- • G(�+�•Dnpth of filter materiel /� Total length... ..�V...... Seepage Pit: D;slance to nearest well Distance from foundation...................Distance to nearest lot line............... N Number of pits Lining material... Site: Diameter. ... .. .. .. Depth......... ...................- ,,J Cesspool: Distance from nearest well Distance from foundation Lining materiel.. ......... ..................... C) Site: Diameter Depth Liquid Capacity. L.......................9811!. Privy: Distance from nearest well Distance from nearest building. . ... ......................:.-': ❑ Distance to nearest lot line ....................... .................................. ..................... . // - Remodeling end/or repairing (doscribo): Ll-. ....... .r'�, !�/ ^"':'...a...~ ............................................ 3 "# .................... ...............................................I............ iA, ........................I.....M1eaeerdana.with...an.•........................ ... Ya hereby rlarth that I have prepared this application,,... County y tore and that the wort Will be dere Joaquin Cetsssty ordinances, State laws, and rules and regulations of file-San Joaquin local Health Disfrief, 1 C-�� t (Owner and/or Contractor) } w J Bl.. ......_.................... ....G.I. . /. _ . .. . ) .. y .. (Plot plan, showing site of W.loceflon of system Fn ralatlon to woNs, buildings, etc., can be placed on rew"a o{. FOR DEPARTMENT USE ONLY . .---�� . --�-,�sze.W• _ ..�-�.-eraserWas �.. APPLICATION ACCEPTED BY �..._ DATE a' �..' 2.Y.......................... REVIEWEDBy ........._I.... .. DATE. . ...........................................-....... BUILDING PERMIT ISSUED . ....... DATE_ ...................... .............................. .. AINra/ions and/or recommendations: . . ........ . .....................................................................I.................. ` FINAL INSPECTICtl BY: u`''/'��-�"'�' Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Muelten Ave. 700 Wolf oak Wolf 174 Sr/ernore 11reN 201 well 0101 111e4114 Ned►en,cdltere le Lodi Gel;lernle Mentors,ce111NnIe Italy,California 1 ,. v NA 1 67 V-4va,A 1"n.1