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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. f..............--- ` L ---------------- - -------- ------------------- -------- (Complete in Duplicate) --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ^� This application is madye.i�n compliance,-wifh County Ordinance No, 549. JOB ADDRESS A CATI N.-/ 1 f,1 .> {o-------r4----- o•--- Owner's Name------ --------------- Phone-------------------------------- Address- 4�� J -------- �r -------------------------------------------------------------------•---------------- Contractor's Name------ �.v �s ---------------- ------------------ ------ -------- Phone ............... Installation will serve: Residence ❑ Apartment House E] Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: `-_ Number of bedrooms --- Number of baths =__ Lot size _ -- �__ "_________________________ Water SuPPIY� Publics stem Community system ❑ Private &/6epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam R4-Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------- No '~New Construction: Yes ❑ No ?�F- FHA/VA: Yes ❑ No��]r-.� _ TYPE OF. INSTALLATION AND SPECIFICATIONS: --(No septic tank or cesspool permi#ted,if,public-sewer-is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--.--_-_---...___-Material---------------------- ,..___.___._._.-_________. a No. of comparemems Size r Liquid depth Capacity - DisposalFi I� Distance from nearest well Distance from foundation___� .___,Distance to nearest lot line g,�_ Number of lines--_.--_ ength of each line-. '-__;, Width of trench_-��----- Type of filter material - . . . Depth of filter material___� `r_.._..Tatal length__, _ ____�eepa5ge Pit: Distance to nearest well_____________ ________Distance from foundation--------------------Distance to nearest lot line_______.__.___._ ❑ Number of Pits------------------------Lining material Diameter----------------------- Depth____.-.-_.----.__---- F ` - ---- ---- Cesspool DistanceDiameter nearest wel--- Distance from foundation � -lining material------------------------------------ El ..._ - --- -- ❑ SizeDameter. -.-.-___Depth Capacity- _ ....gals :Priv ' Distance from neares±well-_ f r",.ry'~.❑ ...,-L! =.---w�M D.is>-t'a�n-c-'�e to Dista'nce from nearest building__---- ----------------------- --------------------------------------- ------------ --------__ ----_ - ---------- nearest , . lot line-------- ------ - 4 Remodeling and/or rep firing (describe:_...--.-- _ -- -----= --�4wo_ - --- -------- -- -- - ------- ----- ------------.- = ----------------------------------------------------------- - ----- -------- ._ ---------------------- �. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and reg lations of the Sa Joaquin local Health District. 9 Y _j Signed)-------------------------------------- t t orj ------------- �-BY-==-=------------------ ---------------•-�__—_-- �-- . - ------- - Con rac---=- - (Plot Ian, showingsize of lot, location of s stem in relaf o wells, buildings, efc., can i;e.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .L � r -------------------- ------------------ DATE----- j .� �_. f SREVIEWEDBY------------------------------------- ------ ------------------------------ ----- • =-_:. DATE--------------------------- ----- y >BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------`--------- ",--: DATE- • j '�- .. AIteiations and/or recommendations: - - --------- ------`------------------------- ------------------------------------------- ---------------------------------------------------------------- --------------------------------------------------------- --------- - ----------------------------------- ----- ---------------- H .._ ._ _. � -------- .__. __._------------------------------a-.._.__.__..___. ............----------------------------------------- - ----- --- -- --- ----- --- ------ _ ----------------------------- f y Date = �L� -- - -------------------------------- FINAL INSPECTIO BY:- �E -- ------ ----- - _- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E..Ha:elton Ave. . 'Wes 300 West Oak Street 124 Sycamore Street 205'West 9th.St e * J 1 \Stocklon,California Lodi,California ~_ Nlariteca, Calrfornia Tracy,California F.P.CO. + ,f