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A ' APPLICATION FOR SANITATION PERMIT Permit No. 10 .'-...__ (Complete In Duplicate) _I _�_ Ile f1I.��! Oets Issued I ,+, Applica+ion is hern'.�y made to the Sen Joaquin Local Heah"i District for a permit to constrvc4 and;m+aft the work herein described. This application is riadm in compliance with County Ordinance No. 549. ........................................ ....11...11...__....... —... i r / . .... .. . ��. JOB ADDRESS AND LOCATION....�,.....�.`.f- .-• •- - - T�ht•�•�' ,� c,�,��->z,�sc..-... _... ..... _1111. phone.................. ,.. �,aT'..- ,. . _1111 �§ Chyner t Name.... ••• Adc+ass.. ..........��Z:"'�..1. � ... �f...............................:.......... ..............................on ...... ..- -• Contractor's Name .. . ...... . �� ...................... ..... ... Ir+ctellation will sane: Residence j�AFartment House ❑ Commercial ❑ Trailer Court Q Motel [3 Other ❑ Number of living uni+s' l Number of bedrooms J.. Number of baths Lot ioe .....�.ll...`...... "- - - - Water Supply: Pubic +ystem p Community system ❑ Private Ij''Depth to Water Tebb 0-ft. Character of soil to a depth of 3 feet: Send❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe&1-lwdPon❑ Previous Application Mede: "es 0 Nu P-'New Construction: Yes ❑ Nom" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank o,ressF+ol permitted If public sewer Is available within 200 het•) Septic Tank: Distacce from nearesr well..... .... ..... Distance from foundation........ .........Materiel.............................. -_..._ .. ................- ' id dl+ K.........................Ce No. of compartments... _ 1111 ....... ...Sia........ . . . Liqu' P Peu1Y....... _T��_/-/ i Field: Distance from nearest well �0.......Distance from foundation--.......... Distance to nearest lot rn��!T__.. Number • ..._. Length of each line.... Z—_ of trerch.........q�y.- Type of filter es nater el...�� .�P of filter materiel....W........Total Iength............ ai0�... __ .. • Pit: Distance to nearest well. ...................Di.tence from foundation......._.»..._._Distance to neo.est lot Number of pits................. I.thing rrseter'ial.....................Site: Diameter........... ..._ ...Depth..............._ cesspool. .............Lining materiel. Distance from nearest well from foundation gam• ❑ Size: Diameter. ..,-...... Depih..»............._.. ......._...................Liquid Capacity--------------- Privy: Distance from .itarest well.......... ...............»............ .Distance from nearest building...... .� �. ._ Distance to nearest lot lint;..... .......... ._. .....-.....-... 1111.»_.._:._ — • Remodeling and/or repairing (deseribe):...� --» - 1111. .-..-1111.. » 1111. Y _1111. -. -....... .. » »»....... . ,.. ..... � . _ ..-1111 _. ... / ,,,_ 1111.,,, � a+n 11:11--- _.. ............................... . » coardome with San Joaquin County I hereby certify that I have prepared this application and that the�SrkwlM Ise hs e ordinenc+s, State laws, end rules end regulations of ass Jo#gpir+Local Heakh District. �-s .(Owrsar alwor Cootrecterj T ... ....1111 .. _. . ....................................... ..................... 1111.._ - - (1it{e),IaK�d .... .... ... (Plot plan sh wing else of W.location m In r•latfoes to walls. buildings, eta, can be p on reverse e -- FOR DEPARTMENT USE ONLY ('�pPLICATION ACGr PTED BY ;. 1111... .... ........................._.. E�� DAT ,=............................ . .. REbIEWED BY .. ..h .........................................._.......................... DATE-,;;&................................. . ..__ BUILDING PERMIT ISSUE,).............�.............-............................._........................ .............. DATE.....6-..................................-. Alterations and/or re,.ommendatans:...................................................... ._..._................................ _._.._._.._..... ....._..............................I..................... _._.._..._... _. .................... . ... _._ ............ ..... ..............-...s.. ..................................................................-............ -....__..._... . y .................... `... . -:.. ...................... '+ FINAL 'NSPECTION BY:. C/.1. ......................_........ Date..... ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sovih Amwrkan Siraa4 300 Watt Oak street 132 syeaaro» StrN1 914 N" "C"Sir**! Tracy. Cafifernia SfocNor on, C+INn'a Lodi, Califernie MaMeea, CalHarnia rev—w—a... ,1111• r��.n �a.•