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FOR OFFICE USE: •------•-- --------------------- ------- - / --- . APPLICATION'FnR SANITATION PERMIT Permit No. ....1.�a .......................... (Complete le Duplicate) / ............................................. I This Permit Expires 1 Year From Date Issued Date Issued ... 1. ..:�..L Application is hereby made to the San Joaquin Local Health District for a permit to construct an stat a work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION. � �� srir .._ . .. . ........ .... .' cS.. ... ...... ..r`.7. �...... Owners Name......... = Phone.................................... 4 Address.......... : ... ... .... Contractor's Name.: y�/iraraei. !r...............•---------•---•----•-----•------------------••-----------•--•--...---•--.......--------•---._.._.. Phone................................... Installetion will server Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: t..... Number of bedrooms .J.. Number of baths &A.'... Lot size .....Z�.t�1�-.a Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table 4A ft. Character of 04 to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay❑ Adobe❑ Hardpan❑ Previous Application Made. .(If(If yes,date____________________) No New Construction: Yes DI No ❑ FHA/VA: Yes Q`' No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is availeb6-*Wr fQet• Septic Tank: Distance from nearest'well Dist c� f. foun atron.j - ---:M t nal--- - •.......................... No, of compartments.... -r.............Size_/+e .. _..Liquid depth..._: .._..__.__._._Cepeeity..f.I! .... Disposal-Field: Distance from near? t welL_4-I?-------Distance from foundatiV_19.........Distance to nearest to lineNumber of lines_.._. ' Length of each Ilne_.._ /Q..Width of tronch.. ....._s y ..��JJ� �`�./ !,.0 Type of filter mete la .IF&"_.Depth of filter materiel ..� .......Total length,.. A...... r` `' 'f Seepage Pit: Distance to nearest wel----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of'pits......................Lining material----------------------Size: Diameter........................Depth................................. Cesspool: Distance from nearest well.............. 'DiAonce from foundation....................Lining material..................................... ❑ Sizer Diameter......................................Depth--------------------------------------.........:...Liquid Capacity............................gals. Privy: Distance from nearest well----------�.....................................Distance from nearest building.......................................... ❑ Distance to nearest lot line.............-------- - ..... - Remodelingand/or repairing (describe):...................................-•----•••---•••••••----•-•---....--•-••----•---•.................•-•---•-----.............--•---••---.........__-•--•- •• •-••••-•...----•--•- •--•-•... ......... ..............•••-•-•-•--....•--•-------------. ....••---...-•-•-...••••--.................--••••-•---•-••----•--.........-••-••••••......---• ......•. I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rulesnd regul tions of the San Joaquin Local Health District. • (Signed)......... - --------------------------------------------------------•---••-------------•(Owner and/or Contractor) - lr _ . �! --- •-•----• ---- ---- ttla� _ --,_- (Plot stye"a oty a rst�un is re#ation to wok bWWhit ;, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y . --•••--••••••-- DATE. .-:•-----------F. ............................ REVIEWEDBY . ..__... --------------•-.................................. DATE........................ BUILDING PERMIT ISSUED... ..... . „--•••- ••-••--••-----••-----•--•-•-•-••---...-•----•-•••-....... DATE............... Aboratioet and/or recommendations: -••--•- • -------•----••---------•------••--••-•-•-•---•------••-•••........•--••-----•••••................•-------•..........--••-••................ ..........................•___._..._......-.._.._..:........................__F..._................_._._.____......._................._....................................................................................... .......................................................................................................................................................................................... FINAL INSPECTION BY0,11441 l -•----------•----- Date.,K4, ' 6._;L............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street st"Mon,California Lodi,California Mentees,California Tracy,California Ee 9 W[VIE[O 8-59 2M 5-e1 ATL"` t