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FOR OFFICE USE: 4M _ .. . ... ..... . 'APPLICATION FOR SANITATION PERMIT Permit No. -- -- - (Complete in Duplicate) Date Issued _____. ------------------------ ----- S -- -----------_- This Permit Expires 1 Year From Date Issued ---- ------ Application is hereby made to the San Joaquin Local Health District for a.permit to construct and install the work herein describ d. h This application is made in compliance with County Ordinance N . 44. j AD CATIO -- -- - ----.t._ --- ------ - --- --------- -- / � ---- Phone--, Owner's Nadne-------- -------------- ----------- ---- -- - -- --------------------- ------ Address-----------------------• Q D -•••-•-------------- - ----------- y' .4--- - Contractor's Name------ ----------------------- - --�`----- - -------- Y i-------------------- - Phone._ ----•--------- - Installation will serve: Residence Apartment ouse El Commercial E] Trailer'Court❑ Motel ❑ Other El Number of living units: __�---- Nu er of bedrooms _1--- Number of baths __�_._ Lot size ___ --�--�••-I- r Water Supply: Public system Community system ❑ YPrivate ❑- Depth to Water Tablet, 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan [IPrevious Application Made: (If yes,date ---------- No F1 New Construction: Yes ❑ No FHA/VA: Yes ❑ �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # I No septic t k or cesspool permitted if public sewer is available within 200 feet.) x I r e a �jios�lanfce from nearest well__--_..__-_____Distance from foundation_________________--_.Material_____-..-____._--_.__...---___.__---___...____._.. ocompart ierts-------------------- -----Size-----------------------------1--Liquid dep. -------- '-------- -Cap city_=-------- ---�_- t tion__ __ '.__. -_Distance to neareslot line__+_____. p -. ejP---------- t o al field: as ante from nearest well_ _s Q�4..Aistgnce from founda+ � - Width of trench_ Number of lines____ ____ Length of eaci� line Type of filter maferi [s. _ .Depth of filter material___-._ -_ __�� Tota4 length____________ __ t Se ge Pit: Distance to neare�t welf__ _ 014LO.---Distance, nom foundation_______ _____ ��bbstan Ito nearest lot Irne-__'____-_____.. Linin material__ j'_ . Size: Diameter.-..x�t-3 .._.Depth-__.d� .-_ Number of pits--- --------- ----- g Cesspool: Distance from nearest well-------------_---Distance from f undation._----------....... Lining material-------------------.____.. -____ls.__. x ❑ Size: Diameter---- ---------------------------------Depth------ ---- ----------------------------- ------Liquid Capacity ---------------------- ga6 Privy: Distance from nearest well__________________________ t.____------Distance from'nearest building-------------------------------=--------- Distance to nearest lot line----------------------------------------- ❑ ------------A---------- Remodeling and/or repairing {describe}: - H V 11; 1 -------------------------------------------------------------- --- r 1 hereby certify that1have"prepared this application and tha+ the work will be done in accordance with San.Joaquin County ordinances, State laws, ales and regulations of the San J kLol Health Dis#rict. -------------- caner an ractor] Si ned --------------- --- - - -{ 9 )------ Et "t"f 'I'7ANFC SE3�Vt�EBY16 MinerAMg.t----��'S'3841 Y----------------------------------- - - -----(Plot plan, showing size of lot, location of system in relation t elgs, -can,be p a on reverse side)..... # FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY- ----- DATE ,°- �j `rT ----- t'— DATE--------------- --------------------------------#-------- REVIEWED BY. `--------- -- -------- BUILDING PERMIT ISSUED----------------------------------------------------;--------------------------- DATE. Alterations and/or recommendations:---__. rte_. -� r -' --= - -- -------------- --- ---- - --------- -- - - ------------------------------------------------------------- - --------- --------------------------------------------------- FINAL INSPECTION---------------- -------------- Date '=�r tc`_Y.0 y t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nat:enon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street 4 •'**, Lodi,California Manteca,California Tracy,California Stockton,California