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FOR OFFIC5,USE: ....... ... . ....... ............................ ............... APPLICATION FOR SANITATION PERMIT Permit No. .. ....................................... ....^..... (Complete in Duplicate) ------ >--'----------------------------------- This Permit Expires I Year From Date Issued Date Issued Appfication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made.in_complience wifh.Comr}y Ordinance No. 544- 4.... 3v^/.S.300 ;.;.: jee r!zt.�.�.JJOB ADDRES�AND LOCATION_S/�� Phone..........._...... . Contractor's Name...... ..._r.=�f'lFs.GG.�s1� ...._.... .;• �I�fjl Q.---.--- pf 0...._.____.Q Installation will serve: Residence Q"Apertment House ❑' Cor0' ial Traver Court Motel Other Number of living units: �..-. Number of bedrooms_;<NNumber of baths _.r.-__ Lot sore _Jed � Water Su • Publics stem �— -� PPIY• Y ❑ Community system ❑ Private L'�Dep+h to Water Table :._.__. ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan Previous Application Made: (If yes,date.........-....- ....) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ "p TYPE OF INSTALLATION AND SPECIFICATIONS: I" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Dis+an'ce from nearest velr .'--_...Distance from foundation. MeferieL....__._____.__....._._._. - --— ❑ / No. of compartments---__- _.___.........Sim_---_.------ Liquid depth..._............._....Capacity__._.._.__.____ Dispos9Vp old: Distance from nearest well..... '__Distance from foundation.....IGR------Distance to nearest Number of lines-------/------ 6f each of Type of filter meteriaL_...__ _._Depth of.filter meterial_.lp. ' .._..Total length..... Seeps Pit: Distance to nearest welL.._.1_B4k'1.Distenee from foundation..L.0 .....__Dist n. to nearest lot line.`�e_.., Number of pih....../-.-..--..-Lining material..... `_.__Size: Diameter-----7 .... ..Depth---A:.5.'_......... ... Cesspool: Distance from nearest wol_._-__.. Distance from foundation........_-_...Ltning material........ ..__— ' ❑ Size: Diameter....----------------- .. .._.__...._._._._._____...___...Liquid Copacify,...____,.___.__geh, Privy: Distance from nearest wall.......................__.. ..._._.........Distance from nearest building.,___..-_.._•_.—_. ._ ❑ Distance to nearest lotline..F,.,,...._..__....Y..._.r,___.....___.____._.._.._S.............�____._....�.—�_.._____._._.,_ • • .i Remodeling and/or repairing (describe).._. .__.._x.,r'•_s__._______:._..__._....___.__�.—...w....____e..._..�_ .._ .. ....._-----........-...... .........................__---------------------'----------__,,.---------...-............ -----__._""----_-----.....-- _.- -................ I hereby certify that I have prepared this application and that the work will be done in aooerdsacia with San Joaquin County ordinances, St s, and rules and regulations of the Sen Joaquin Local Health District. (Sign -- .-- --- -- --- -__-- --- _ ndd/or Contractor) - ---- -- - - _- -....------._•. - y'!...a T .......�.__..._....._.. .. -._.._._.... ..._..(Title- ----.......................---._..._.------------•-- (Plot plan. owing sae of lot. of tem in roWon to walk. buildings. eto., can be pleced on reverse side} w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... .........................-.........._...... DATE.-/-.......: ?..,.._-----..-.....,_.. REVIEWEDBY----..._.._....._.---------------------.._.-.._--------------•----------------------,._------------------ DATE-...------- BUILDING PERMIT ISSUED_--__--,----____---------------_.__._.__.__,..__.._._...___....__._ DATE_. _ Alterations and/or reaommendatiare-------..........................___----------------_. ....____.- __._._..._....__._.__...................................-..._.............__.......__......_—.._.____._.._.._._.-- ^_._..__^_.._.—-------------..----. ._._.._ FINAL INSPECTION BY:��-00 - � __--_-._,-_ Date./�� ------._..--------- ___.-_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.naxenan Avo. 300 IN..,Oak Street 124 sycamore Stn 705 Wasl 9th S~ s"Alon,Caiifornia Lodi,Canfamia M.m.'a,Celilomia Tracy,Calffe•n la