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FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> .............­­ <br /> �/...... ................ Kemple" In Dupr1"+aj Dot* Issued <br /> . ..................... .­ - -...­­ I This Permit Expires I Year From Dotle Issued <br /> Application is hereby made to the San Joaquin Local Health District-for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinanc No. 549. <br /> JOB ADDRESS A ON *,.a;, 0&_ -------- <br /> Owner's NornOr...­1......... ......... <br /> Address...._. . ............. <br /> ...... ....... .............. Phone......---_--_-_------------ <br /> Contractor's Name...... ...... ...... <br /> Installation will were: dance ❑ Apartment House ❑ Commercial ❑ Trailer Court [3 Motel 0 'Other <br /> Num6or of living units: --,- Number of bedrooms-.-m. Nrn;ber f6aths .l. Lot saa .......494�-�- ....... <br /> Water Supply: Public systam [] Comrnunitysystorn C] Private - <br /> teDepth to Water Table ......- ft. <br /> Chsir"4w of sop to a depth of 3 feart; Sand 0 Gravel [I Sandy Loam 0 Clay Loam[I Clay [I Adobe O/Hardpan C3 <br /> Previous Application Made; (if yes,date__..... .........I No 0 Now Construction: Yes [] No E] FHA/VX Yes [] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No sapft tank or cossiFl,*W permit$W if pu6lic sewer is ava&66 wAin 200 feet.) <br /> Sept k Distance from nearest wall......-0 f Distance from ioundaficr......101. _141 t <br /> No. of depth....... Capacity... E?4 <br /> Dispos Field: Distance from nearest well....019P.....-Disfance from foundation.....1A.—.Disfance to nearest 62+ line........., <br /> Number of ..Length of each line......... of french....?n............. <br /> Type of filter rnisterial--.4'. " -..Tc+al <br /> _.X'_.__DepA of filter material....11...... <br /> -once to Ale <br /> _e e - <br /> Distance to nearest well...... Distance from foundation... _-Dilt nearest tot <br /> ❑ Number of pits... .... ...Uning material.._.. ...... -.3m.................. <br /> Cesspool: Distance from nearest well...__.-Distance from foundation.....__..- Lining material................................... <br /> 0 Size. Diameter. ... ..._.. --......-Liquid _...gals. <br /> Privy: DIsionce from nearest ...... Distance from nearest <br /> F-1 Distance to nearest lot line....................., ......... <br /> Remodeling and/or repairing <br /> .................... <br /> .......... ..... .. ..... .............................. ............­... ._._.._..1...... .................. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> of the <br /> ordinances. Stat s, and rulos and rag Ion of Joaquin Local Health Dlsir;cf. <br /> ......... ......................... 4 r and/or Contractor) <br /> By--.- Nrg <br /> . .......................... .. . ............. <br /> --------- -(Plot Plan. showing An of 6f. location of syst 6 re aflo to wells, buildings, can 6o placed on reverse side� <br /> f I . si — I <br /> FOR DEPARTMENT USE ONLY <br /> 0-5 el <br /> APPLICATION ACCEPTED BY...OKOA94 ............................ ...... <br /> REVIEWEDBY........ ............................ ................. DATE............ ................. <br /> BUILDING PERMIT ISSUED.__...... . DATE........................................... <br /> AiWsiticins and/or recommendations <br /> ............................. ................ <br /> ...........­­------................. ........... <br /> ........................................ <br /> .................... ............­'_­_.­_­­­......................... ........ <br /> FINAL iNSPECTIOrJ BY:_. A_;�-, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.WaRallen Ave. 300 Wail Oak Streal 174 Sytomors 5vtil 203 we"qhh stmilt <br /> Lodi,Cafifamic <br /> I P.rg <br />