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FOR OFFIC-US7* ----------------------------------------------- -------- i APPLICATION FOR SANITATION PERMIT Permit N''d�'. y -.... _._Wit.,,4 ., (Complete in Duplicate] � -------------------- - .--------- - ".." Date Issued r �u�EsT -� � ,�� _..._.__-__. ___flTbis Permit Expires 1 Year From Date Issued Za( _ 430 -3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i ado in compliance with County Ordinance No. 549. �I PQ ry JOB ADDRESS AND LOCATION.! Y- Ilei ..... Qp -----Q-� � lVr. Lam. Owner's Name------------ ------ ------- ------------------- --------- -------------- Phone----------------------------------- -�-� .. Address_ _ �- -----p -' -T-C-19--------------- ---------- ------------------------------ Contractor's Name--------- '_l l _l1] -------------------------------------------------------------------------------------------------------- Phone------------------------••--•------ Installation will serve Residence Apartment House Commercial E] Trailer Court ElMotel ❑ Other ElV"-s Number of living units: _ ------ Number of bedrooms __ ---_ Number of baths 2__ Lot size ------_-Q0----�---.�D ----------------- i Water Supply: Public system E] Community system ❑ Private 19-1-Depth to Water Table . Character of soil to a depth of 3 fee+: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes R� Igo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION.AND SPECIFICATIONS: _ (No septic tank or cesspool permittedTif public sewer is avallakile witliin�200 feet.} ' Se tic k: Distance from nearest well__ _- _Q---Distanc from foundation-`�1-----____-._.Materi I__CONCK�T�_ J610 p No. of compartments_.__------------------Size_�X__ ' _quid depth__ —__._Capacity---__ _ _-.--- _ Disposal eld: Distance from nearest well._!�__5Q--.-Distance from foundation--__f Q__-----.Distance to nearest lot line_ yr_ Number of lines'_..--.-f�......--_--___---___Length of each line-7�_'I---9a------Width of trench_ --____- p_._ #_ . € T ----------------IDistance from `foundation---_-___-_r....... length----------------- - Seepage Pit: Distance to nearest well_.___�u_ '�•� Cess ool: Distance from nearest Well--'. r�ateriaL______ __------------Size: Qiameter_a"____:'.�_.--------Depth-------------------------- -_.-_. ❑ Number of pits_•-"---_-._-�. . .. 41 p .___-----_E Distance from foundation--------------------Lining material------------------------------------- Q, ❑ Size: Diameter-•-!---------- -----.- __w.jDepth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: # ` Distance from nearest well_ __________________---._-------.__ -Distance from-nearest building..-.-.--- --------------------- .--.-------. I aT Dist nce to nearest lot line. ❑ z I I Remodeling and/or re airing Idesc ibea 7?1-5- C •_ 4� -1--F�t-JL __->-•-----mo--------A:VG_ P _Prf----------- -, 0.. 1 t T1-t. r3 RQ.f4 _r41— F �-C K-- -.. 'a } >E ` _ ----------------------------- 11-4&K ---- --- -- ---------------------------- ___-V f1 -4&K-------_1-0 . _ 1 _ //V-----std I hereby certify that I have pr'dpa`red this application and that the work-will be done in accordance with San Joaquin County I ordinances; State laws, and rules avid regulations of Ad' San Joaquin Local Health District: +� l } --------------------(Owner and/or Contractor) gY•------- --------- ------------------------------------ ---- --------- --------- ------- --------- -- ----------------- --- --�------- ----(Title)----------I-------- �-- - -- - ---- � --- ` (Plot`plan;`s}iowirig-size-ofrlot;loca+iolr of system in relation to wells, buifdings�etcs;can be-placed-on-reverse side]. -+-=-��= J ��--•rr^^ FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY........ ''-- ------------------------ -------------------------------------R- DATE-------- —------------------ REVIEWED BY------------------------------------- ` ------- l- `:- DATE-------------------------------------------------------------- ----- ------------ - - - =- ------------------- ------------ ---- - � - BUILDING PERMIT ISSUED------------- ---------------------------------------------------------------------- = DATE -------------- -- Alterations and/or recommendations, -�'-_..� --=j ------- Q- � --------------------------------------------------------------------------------i_---------._.__"._-------------------------------------------------------------------- _--------------_ -----------------------. ...................................................... .. ___-____.. ........ -..__-.--. --.-.-_____-...___-_______._._--_------------.__...-_-_-------_____---____-----_..__._.___-___ i F1NAL INSP TION BY-, -- _. Srl ! Date---------- .C�S�^ SAN JOAQUIN-LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street SIOCIt1Dnl California Lodi,California Manteca,California Tracy,California I � 1 C.P.CO.