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FOR OFFIC5,USE: ............................ -----..............--' _.:..................../...................._..... APPLICATION FOR SANITATION PERMIT Permit No. ..�l _ 7 -------...._._._......__..........._....__-- (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made ;7;e Sen Joaquin Local Health District for a permit to construct and install the work herein described. .. This application is madeincompliance with.County Ordinance No. 549. 3 0S - CSJ-/S- 4-4 Z-04-111 JOB ADDRESK-AND Owner's Na - — — Phorls Wl-.. __. _ ..�.1 ..._.__..—` —.—._._. . Address----- �..--- c r Contractor's Name........-_-._.-.-. .._..... .. ... .. . . ._ ......-_..... Phone...-......_.__ _..._..__... Installation will serve: Residence Apartment.House C]' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. Number of bedrooms ._-T nber of baths J--- Lot size ._.. ... .. __....__. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam p Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date....................I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No❑ '� TYPE OF INSTALLATION AND SPECIFICATIONS: o (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a .>r Septic Tank: Dlston'ce`fiom nearest weir.'._':.----_.Distance ❑ No. of compartments...................._-Size-...:__............_...-..Liquid depth _.Capacity.-._—___.__-_ DisposgYF eld: Distance from nearest well......4�_b_...Distance from foundation.-_j-0 f-.Distance to nearest kN line.. ... Number of lines_-----._/_.__'_'_`Length of eachline__rIB.Q'_� ._1Nid'Fh of Type of filter material_-._. .R_._Depth offilter material_._.1.,P._'—y_..Total ...... See a Pit: Distance to nearest well..._.I. 0.1.,-Distance from foundation-L it�___._._D•stanes to nearest lot line.!��_... Number of pits------/__.....---Lining material..... Diems+er.___ .. _..�._..Depth_._Zy:'._...._..... Cesspool: Distance from nearest well_____Distance from foundation-.-,--------------Lining material. _____._...... ❑ Size: Diameter___._....._.....___._._.....Depth................—_--_-_----..-.-Lquid Capacity_-.-...__....._..._..gels. v Privy: Distance from'nearest weN.__._._...__---_.------_..._._.._.-_Distance from nearest building............_.._—....... .._ ClDistance to nearest tot _.........._.----_..—.___.._._._ —__.i.___._.__...:.....___—_--�...._....._.._... . . 1.1 Remodeling and/or repairing Idexribe):..._. .__----:-,�-=�_ �-_.........._».._....__.._..�_,__»_.,__._ ....... - -... --------- ------- ------- ........---------•-__-_............-............-- -------------------------- ---.___...............--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. St ws, and rules and regulations of the San Joaquin Local Health District. pu .-__ --____._ _ nd/a Contractor) ._._ ..._ .. __....._._..._____.._..._...__.__..—....__..__.... ---------•--- ... -- - ------ - Rifler-----.._.............--... - -----.(Plot plan, owing sae of _n of tem in relatlaa to wells, buildings, efc.. can be placed on reverse side). FOR DEPARTMENT USE ONLY ,av APPLICATION ACCEPTED BY.._ 2 i. . ---- --.............. .............. DATE-..' ATE.-/'Z.?------.�T...---------- # REVIEWED BY.....................-••---------.... ...........---..._---- --------- ------- DATE-..............._._...------------•------ 1 - ._-----------'--- - - BUILDING PERMIT ISSUED-._----------- Alterations and/or rseornmandatioslr.._....._................. _...._-____..__. --..•........---------------------._._.....---___ __ ... - ............ FINAL INSPECTION 13Y i'! '"""'" .. _... Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F. Hazollan Ave. 900 Waw Oak 5110011 124 Sycamore Street 205 Wart 9th Sues} 54"won. California Lodi,California Monhee.Casifarnia Tracy.ealif.,M.