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i FOR OFFICE USE, ...................................-- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .., ..... . .................... (Complete in Duplicate) Date This Permit Expires 1 Year From Date Issued -0 !s —0 o 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here* described. This.application is made in,compliance with County Ordinance No. 549. �e.q 7 P lei '22400 LcwE�S,4c�.4. *moi 7r7'p,_V� JOB ADDRESS A LOCATIONAZ�_ag; Lha` +--Yki.-.'M.. �tf�v-�r Owner's Name.----.. .... .... .. ----- fx_..._ _"=�"fe"�--- _f. _... , _. ..._. l � Addross_.- p.l�.--- �--- •-•--`------�... .... ... .......--- - r ........_--__................. �...._. _..._._.1..+_._... r ?? Contractor's Name......... .... __..a[..,- --- - - -- .............__............._.. Phone..........._..:----_.. _...... Installation will serve: Residence Tf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑- s Number of living units: ...... Number of bedrooms .3... Number baths .�.... Lot size ....... r s Water Supply: Public system ❑ Community system ❑ Private Depth t Water Table ........ ft. // Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam Clay Loam 0 Clay ❑ Adobe❑ Hardpan❑ Previous Application Madi:: (If yes,dote...........:........) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No❑ , TYPE OF INSTALLATION AND SPECIMATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_............_Distance from foundation..................Material........_......................... ❑ No. of compartments..........................Size....... _..............— iquid depth.....................--.Capecity.:._....... ..�....._ .� . Dispos field: Distance from nearest well._AR! from foundation._,/A ......Distance to nearest lot�ine_S...._...� Number of lines.......I....�. s.../.y.. .. Length of each line... .A.Q_!.._.._._...Widih of trench.....4-...,.............--- Type __.O T e of filter matorial.aw2l4-...__....Ds of filter materiel..._ �' Total Ian �Ctl_.._.._.....—.. Yp P* �-•-1�--------- 9th__. •�eepaga"� oar• Distance to nearest well.....1A4_".....Distance frf�ff^^ oundation......R..........Di fence to nearest lot Ina... .. ^ ❑ Number of pits...../..........__Lining material_..-_?es&Z.....-Size: Depth.-%7.._.._...... C....... Cesspool: Distance from nearest well..._.........»Distance from foundation..........._......Lining materiel................... _.._.... ❑ Size: Diameter..........?........._.............Depth..._...........................................Liquid Capacity......... .gels 'i Privy: Disiance from nearest wall_......*.�.._.......-_.................Distance from nearest building....... _...:............. El Distance to nearest lot linel.......__.` _ ... ... _........ ....___-..---'----...................._.._..._.._.._........._.........._._.__. .........- Remodeling end/or repairing (describe): ..::----,-------1____ss._._..,--_.._.-___-.-.-__....... ...._.-_---------_.._-....._.__.�_-.._... .............--._............__......._.._....._ti..:......._.. —....M»_ �.._..........---....._.-...,........................... ...._....._...../...-----.... i ........................_.................._....._..._...!.......`.... �._................._........!..._ __......--- I hemby certi that I have prcparod Aii application and that the work will be done in accordance with San Joaquinn-aunty ordinances, Stat , and rules and regulon the San Joaquin Local Health District. (Signed) .--............................. and/or Contractor ............: By:. _ _.. lit. . _ .. ..-.-- -Tiflel........................................_'................ (Plot plan, showing size of lot, location of rysta' in relation walls, 6uildmgs ate, son los placed on reverse side). v i IFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ......--...._.......-----------------.... DATE---- L'.�a.,S .... .f_. ' REVIEWEDBY-------.................-- '-- -._. ......_ ._...__...._-.....................__...._............. DATE........-......__._......._. ._.-•--•-- BUILDINGPERMIT ISSUED..._...__.._.. _. ,% -._.. L...........__...._...._........�._. DhTE..._....__.._.___---------------__...... t r- Mterations and/or recommeedeficeir................ ........... _..................._-..-.-.._......__.... ---....._..._-._.................. ._...-_'.._...._ f ..............................................._...........__......._._._..�3..-:....... _...................-».._.._.._........._.-.-...-......._i....�.__..._......_._..._._......_.._.. G ............_............................--........................... _................. FINAL INSPECTION ..................- Date_......._...._.............✓......................-----_..—... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F. Naaalten Ave. 300 West Oak Street 124 Sycamore Street Rea Wert eK floe/ •• Sudten, California Lodi,California Marfa<e,California Traasr,Caahrafa CC y RCvi�CL B u4 7M 1-63 r.P.CO. �