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vnv11­1 .c Uor: <br /> ................A---._.------------------------------ <br /> .. � _ <br /> - .-""..--... ARICATION FOR SANITATION PER* Permit No. v2 <br /> ....................... --..�.. ......:......_.......... (Complete-in Duplicate) -' <br /> PP ....."--....... . This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..... �a.<%". ._ <br /> Owner's Name..., . <br /> - �- <br /> Address._.. Phoner � ..._. _077 <br /> ontractor's Name.... ....... ... . <br /> __ .. Phone. <br /> Installation will serve: Residence *--AXpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _. ..... Number of bedrooms -,3---- Number of baths._r.... Lot size ----- <br /> Water Supply: Public system ❑ Community system 0 Private g?-'Depth to Water Table %Q: ft. <br /> Character of soil to a depth of 3 feet- Send ❑ Gravel Q Se dy Loam El Clay Loam Cley ❑ Adobe❑ Hardpan [ � <br /> Previous Application Made: (If yes,date....._.......---.. I NoNew Construction: Yes 8 No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: grll� <br /> (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) <br /> 1 <br /> Septic Tank: Distance from nearest well-.f-Q.0"_,"""Distance <br /> i ..from..fou-;.-"d.,ation._A0_ ._..M-Material No. of compartments.._...._5 ..._ _ Size. y„ <br /> ._. .--- - <br /> -_Liquid depih.� ... ,"..,"_ Ca actty-G24!D " <br /> Disposal Field: Distance from nearest wel(.SO--,._ Distance from foundation... e <br /> ^� -.r.........-Wid h o to nearest lot line._..-.--. \ <br /> !J Number it lines.teri�".-.-" _length of each_line_ ..�Q�....._......sWidth of trench.....Zs���................... <br /> Type of filter• material.. .. __......Depth of filter material_..I f....-- 1 <br /> �, .0 `....Total length._��lt--------------------...._ <br /> Seepage Pit: Distance to nearest well.....S-0""."---.Distance from oundafion....m��....... Distance to nearest lot <br /> [L� Number of Alts.__ .---..._.__-Lining material.. ....... Size: Diameter---Y-X.. <br /> sf ......Depth )a ......... <br /> Cesspool: Distance from nearest well................Distance from foundation................. material. ...........__.................. <br /> Ej Size: Diameter. .. ... <br /> - Depth...-- - - --.-----.......Liquid Capacity 9 P tY - -gals. <br /> Privy: Distance from nearest well.........................................`.....Distance from nearest building to nearest lot line............................... <br /> Remodeling and/or repairing (describe):.... .............................................. <br /> - ......................................­_.................. <br /> ---------._...-------`---`-....--................-------.............._...-----------------...-------...-----------...----...-------'-----.....-`-.--------......--...................................._ <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws, and rules and regulations of the Sart Joaquin Local Health District. <br /> s <br /> (Signed)-- ...... <br /> Signed)- <br /> .. ............ .... .......-- .........._..---- .... ----......_...(Owner and/or Connector) <br /> By:... .. <br /> (Title)-(Plot showing size of'1oY;'looe+ion of system in relefion +o wells, buildings, ate., este be placed o averse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.''r7j9'0:-................---.....------------. --------- --------..__ DATE---- L0--_�7.�..�P'............_._..... <br /> REVIEWEDBY.. ITI- .S.U............_---------------------- <br /> ------------------------•-----------....--------------- <br /> *...--•---.... DATE........ -- - <br /> BUILDING PERMIT ISSUED...._...._._...... <br /> Alterations and/or recommendations:..... tT..."._� �T/}5 ^L�Q .. 1�C.ff-D, --•---oxva t5 .' <br /> (�J.......................................1 FAR .....FiNA 1N.�z Tt< ._. ...t.---------...-----------------...-----•--..........----....- <br /> ............................................................:.................................----.......----.........-------..... -----•------- <br /> .._....--- •---•• ................................. ....... <br /> FINAL INSPECTIQ r / Date........�Q.. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoteliers Ave. 300 West Oak Street <br /> 124 Sircaa Sheat 705 Wert 9th Street <br /> Lo<kron,California Lodi. California Monism, <br /> Californiai <br /> E.H.9 2M 1 67 Vanguard Press rro<y,California <br />