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APPLICATION FOR SANITATION PERMIT Permit No.-_.��-......... ...... (fxl (Complete in Duplicated Date Issued A lication is hereby made to the San`Joequin Local Health District for a permit to construct and install the work herein described. pp This application4is made in compliance with Cody Ordinance No. 549. JOB ADDRESS`AND LOCATION_:_.__-_ _ __-�-- -- -- - -- - •-- -- r . ..,. = Phone ------------- ---_ . -------- Owner's Name----------=---------- I f .� - Address_.--------•--------- ----------------- - ------------------- -----------•------------------------------------------------------•------------------------------.;_....-------------•----- L. r e-f' - c..".-------- -------------------- --- -- ---------------- ---_-------------- Phone Contractor's Name____-_"______________•__-- E " % . I t Motel Other ❑ Installation will serve: Residence -07 . Apartment House ❑ -Commercial ❑ Trailer Gourt'❑ ❑. YNumber of baths 1----- Lot size _`__---7 --- Number of living units: _.��--`Number of bedrooms __- - Water Supply: Public system ❑ Community system .❑ Private � Depth to Water Table =___-__ ft. It Character of soil to a depth of 3 feet:, Sand ❑Gravel ❑ Sandy Loam El Clay Loam [I Clay ❑ AdobgZ Hardpan C3 Previous Application N lication Made: Yes 0,9 New Construction: Yes No El ! FHA/VA: Yes ❑ 40 F1TYPE OF INSTALLATION AND SPECIFICATIONS: i P p p sewer is available within 240 feet.) ` }ic Tank: Distance from nearest well___�� ---� our {No septic tank cr cess ool ermined if ublic se Distance from faundatiori"'��Q_�*-------Mat en I--------------------------------- -----------• Sep .. No..of compartments-------,,�_______-_--`-Size__ 'qq -k_q_X•_Liquid deiip0-------------------------- -- i t 1 Disposal Field: Distance from nearest welG.` ----:-Distance from foundation____ld--------Distance to nearest lot 16- -line a 50 Number of lines----- -- --- - -- Length kof each line------------------- -------Width of trench.------ . - _- ------=-;-• Type of filter material- -- p fefilter material----- / ---------Total length----------------------- rest wel ____ __________Disfanc' from foundation_=..=__.____..__....Distance to nearest lot line......___--.__-._ ___De th o Seepage Pit: Distance to-nee W^ Number of pits - ------------ Cesspool: -`-!Lining material_�.1': =-- I -Size: Diameter------------------------Depth------------ Cess❑pool: Distance;from nearest well-------_'_J Distance from foundation_._. -------- Lining material-------------------_----------____.. , ❑ Size: Diameter------------------------------------- Depth----------- = =------ = Liquid Capacity gals. Ni \ { Distance from nearest well_______________°-______--,4,4- Distance fromTnearestbuilding_____-___--____--------.---------------- h Privy: i. - ----------------------------- ... '... ❑ y - and or Jpairinqdesares0 me ---'•--------•--------------- Distance one ,Remodeling / I ):------ === ti = � =-------- _ -f. I - -- - ------------------------- -•---------------------- ----------------- -----------------------:-- --- -------------------------- ! --------------- ---------1_____1 ------ --------------- = --=----•--------------•------------------------------••-------------------------------==-----=-------------------------------•--------- --- _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State 1 s, and rules and regula ions of the San Joaquin Local Health_.District. -----(Owner and/or Cont d/o ract or> (Signed);,, ---------- ined _ 1 ---- ------------------••--- ) (Plot plan, showing size of lot, location'of system ins relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY ------ DATE-----------/ I1 ---------------------- REVIE V BY -------- ------------------- DATE------------- ------- I -----------> --------- BUILDING PERMIT ISSUED__.. s --------------------------------------------------- DATE ------------- ------------------------------------ -------------- Alterations = Alterations and/or recommendations__________________________ ---- --------------------• --- --- -------------------- - ___ A) Date__" = FINAL INSPECTION BY:._ _.-f.��--•- ------- -- ------- ----- --- '� SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Streef 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, Califomie y. ES-9—.21x1 Ravisetl 1.57 F,?.CO.