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_ *ICATION FOR SANITATION PE )Complete in Duplicate) Permit No. a �— This Permit Ex ires 1 Year From Date Issued ed Application is hereby made to the San Joaquin Local Health District for a permit to construct and install De workate herein This application is made in compliance with Count /—� r y Ordinance No. f549. fo JOB ADDRESS AND LOCATION-..-._1 --- ------------ Owner's Name-- ------ . Address_. .: _._.. - - .... - i - - - - - - e �.er�.:Z -.sC?.7.7 Contractor's Name.�'upX !G� 7- --' - Installation will serve: Residence Apartment House ❑ CommercialCourt Number of living units: -- ----- Number of bedrooms _ .--- Number of baths Trailer ❑ Motel ❑ Other ❑ Wafer Supply: Public system ❑ Community system 0-3 Private ' , SAg _.-. - Character of soil to a depth of 3 feet Sand Depth to Water Table G'. ft ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ®� Previous Application Made: (If yes,date_._._. ____-. TYPE OF INSTALLATION AND SPECIFICATIONS: I NoOO-'�New Construction: Yes EKNo ❑ FHA/VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-./002---� Distance from foundation.-"'-------. _Material_.4�-�/L¢.C2� ®' No. of compartments --' ......... Size_by-11 ."41----.Ligwd depth--�.�- ... - - --.....---U- --- Disposal Field: Distance from nearest well-M-./ --- -- Capacity.1-242!_,� e Distance from foundation.-..el.,�-.'.......Distance to nearest lot line... -�_- 1� Number of lines _..--.2_-_-.-.--- Length of each line-. rG ...........-,.Width of trench-_-„2-- ��__..-_.- T e of filter material-- i. yP Depth of f Iter material l p--_- i o -----.Total length---1�Q!........ - - Seepage Pit: Distance to nearest well.--_S� Distance from foundation.--. ---..Distance to nearest lot line Number ,p� � � i [� Number of pits-_--_�--------Linin material-_ - 9 nllf-A - Size: Diameter---Y-�t-----Depth----19---------------------- 0 Cesspool: Distance from nearest well--------------_Distance from foundation-_.---..-.-,---. _.Lining material .-___.-..--..-__-..-_.. Size: Diameter. -. ..------- - - .Depth.. _:-._ Liquid Capacity _....-...gals. h Privy: Distance from nearest well-------------------------- from nearest buildingy El Distance to nearest lot line _Distance_-.-....----._.-.._...------------------------------------- ----------.--...- Remodeling and/or repairing (describe):------------------------------..-......... -------------------------------------------------..----------------------------- ------- --- ------------ --------------------- --------------------------....--------------------------_.-._ . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Joaquin Local Health District. (Signed)- - - ....'. �'6n / Contractor) ,p - -(Owner and/or on rector) By. y - - - - - ... -----(Title).. -- _ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed o everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�7- 7- - '----........ ----------------- ---------------------------------------- DATE- REVIEWED ATE REVIEWED BY----------------------- ....- - - --------------------------------------------------------------- DATE---------------------------------------------------- BUILDING PERMIT ISSU®------- .. ---.---�j-T h r�.1 .w../.'.------------------'--.-...... 5� T. Alterations andlor recommendations ./'-L-[..-..--Y.FPr-!7 1.�--OT---f�N� -KFY-.EW V.Fsr-.KF.P . ............... - - -- .... 13 Ft?R .-.-.ANAL....[MSF T.-c42n(. ..... ........................................._.................. ............ .......__.--....------- - .............._.... - ._..--....----- ----------------- - . --.... . .....---------...-- - .-_.._..... ....--....._._...------ ..... .................................. . - .-.....-... _......... ....._. ... _..-- . .. .. - - - -------------.-------------..---------------------------------- ----------------------- M --------- -------- -n "Z.2-FINAL INSPECTI6 Date.. ..,.... . ._ e ^ -- ------------ - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Massillon Ave. 300 Wast Oak Street 124 Sycamore Street 205 West 91h Street Lodi California Manteca,California Tracy,California Slocklon,California in u.eft%xM0 %