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FOR OFFICE U5E:
<br />APPLICATION FOP, SANITATION PERMIT Permit No.
<br />(Compl >te in Duplicate)
<br />This Permit Expires 1 Year From Hate Issued Date Issued.....__.
<br />.-.. ...� --ns
<br />I Application is hereby made to the San Joaquin Local Health Dis'rict for permit to construct and install the work e in rhe r, d.
<br />i This application. is rnnde ;r, r � nnlirince with County Ordinance No. 549. s /y��%
<br />JCiB 7�DT7RES5 AhIS'L y 1 lv :.,�'l?'.t?.-�'j�'✓�`�' fxAZOG`. _....,1. J....�
<br />Owner's Narre._.We...�r.,. �Ir�Zd�,�`� Cf't_ .._._..... ........................__
<br />Phone... �..
<br />9 I
<br />Address ........
<br />' `...... _.......... .._ .............. ..................... ....... ..,
<br />Contractor's Name_....-.._..� t�� """� ..�"" _.:.,. Phone. .............. ---------- ........
<br />Installation will serve: Residence Apartment House Commercial E] Trailer G4 [ Motel 0 Ofer
<br />Number of living units. Y.- Number of bedrooms Z- Number of baths J... Lot size .r "?Of ................
<br />Water Supply: Public system El Community system [j Private ;�J"Dnpfi to Water Table
<br />Character of soil to a depth of 3 feet: Sana 0 Gravel (j Sandy Loam 0 Clay Loarn Erl Clay © Adobe j_„_,`� Hardpan
<br />Previous Application Made: Ilf yes,dote ..................) No R-- New Construction'. Yes ' "iJo D FHA/VAS. Yes W:""" No F,
<br />TYPE OF INSTALLATION AND SPECIFICATIONS-.
<br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br />i Bootie Tank: Distance from eesrest we1i._ Dist nc ¢from f •daii �..s'.-,........t�ate a'..0 •.e.£ -te e! _...
<br />,,,�• r�
<br />Nu, of coir car#ments_-.,---:Siz t - ir�uid dep:f`i..._..'�' .. CaorcitY, -
<br />Disi;osrr Paid: Distance +rvm nearest wei,.ia Distance from foundation p......,..f,stance to nearest lot line
<br />�� ✓'♦1o'.r, ...._ Width of trench.a ... ......,..
<br />Number of lines •---„0.'�.....�,, ..�:iidiength of each line. . ��r
<br />Type o? filter material Af epth of litter riater:al..♦�a-----_-_.._. Total
<br />,,,rr” /
<br />Seepage Pit: :Distance to nearest well., _.Distance f m fo ndation..3...-._. Distance to n,-est lot i ne.... ..
<br />,,,.,�� 4
<br />Number of s... ♦ t� i� S: e: Diameier,
<br />pit a� _._ ... L ning :material_
<br />i- i
<br />C.esspoai: � material-
<br />Distance from nearest well......... Distance from foundatiWn........ _. ,Lining mrst�arial....- ..,. _..
<br />Sze: 17Yzrnnet>r;r -.. Depth f .._. ........-., - ri p '#y.. ..... I
<br />�
<br />Privy: J:stance from mea
<br />... Dirlmrco frcm, n8iarest builr3ing............... ..._.. est well........._.- ...., .. _... ,
<br />o E-1 Disiarce to nearest lot 'me _._._.. ...... ._......... --.......... ........................ ...
<br />�tE?iEk4�P....... .
<br />,ter,
<br />Remode?ing andor reps' ring idesc'ibej:.... .......--._......., .._
<br />i_....._. # _ .............
<br />No I hereby certify that i have prepar<id this application and that the work will be done in accordance with San Joaquin County
<br />ordinances, State laws, and rules and regal lions of the San Joaquin Local Health CJistrict.
<br />{Signed) �2� .-.
<br />jol
<br />(Pio# plan, showing size of W. location of syst n rela#ion +0 wells, buildings, etc., can be placed on reverse side)
<br />F�'Jfi DEPARTMENT USE ONLY
<br />i. APPUCA ION ACCEPTED a-y-..$ cam/,y'. - ..... �� DATE ���%� .._...
<br />i REVIEWED $Y. - DATE........ ......... .. ..._..... ... ......_...._
<br />BUILDING 'PERMIT ISSUEi3 _ DATE.....�,��. ..
<br />Alter tier and r reeam endaticins.........
<br />_............... . .. ..... ..........
<br />r-rr .
<br />w.. .._... _..................... .... . ............................ ...,.
<br />(M Date..-... ..�..+f✓✓U.,......,._........................»_......
<br />FINAL INSPECTION BY:- .{_........ ............. .... ..
<br />SAN I.AQUIN LOCAL HEALTH DISTRICT
<br />�..
<br />1601 E, iltixeiton kwr
<br />300 West oeL 5r,net 134 Syrarwnrt irrtet 205VJesi 9th Street
<br />.,, 9ieYklon, Cali#ornia Lodi, Caiilornin Manure, Coiifornia Trocy, California
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