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FOR OFFICE USE: l APPLICATION FOR SANITATION PERMIT Permit No.12-1------.__ .. ----------------------------------------- P2------ (Complete in Duplicate) . ......- This Permit Expires 1 Year From Date Issued Date Issued . .-r _._._ � 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 made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...of-�4 . 0�-70e,, - ----------------------------------------------•------------------ Owner's Name---------/(4.4:.1 t----- ---------------------------------- - ---.-- Phone------------------------------------ Address------ � ?�� Contractor's Name-------,/'�•CL9f — f> J"------------- --------------- Phone ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___,__ Number of bedrooms J__ Number of baths —_f-- Lot size _____ ---------------- i Water Supply: Public system ❑ Community system ❑ Private 8e bepth to Water Table .460 ft. Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan El Previous Application Made: (If yes,date_ __________________) No AL New Construction: Yes ❑ No FHA/VA: Yes ❑ No [4' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Se tic Tanl�:,- ` Distance from nearest well_________________Distance from foundation____.______________Material------_._________._.___._._._______.-_________. No. of compartments---------- ---------------Size--------------------------------Liquid dep h------------------------.Capacity---------------------- 01 Disposal- Fiehd: Distance from nearest well_-/��_-_Distance from foundation--------------- to nearest lot line__��'�________ Number of lines-----___ Length of each line__`-_ _�f___ Width of trench.. _______________________ Type of filter, materialf_� Depth of filter material../27______---- otal Seepage Pit: Distance to nearest well.__'_" "_Distance f m fou dation___lp__�___Dista c to nearest lot li e_ _�__P____ Number of pits-----�_______------Lining mate ria l_#P _�_1_.Size: Diameter__- -__-__.____Depth_rr �_________-________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_____.______________-___--_________- ❑ Size. Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity. -------------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building______----------____-________-__---___--. ` ❑ Distance to nearest lot line------ ----------- -------------- -------�-----------------------------------•---- --------- --------------------------------------- g /� p Remodeling and/or repairing (describe)----- ---------/7- �/---10V------�`G-�.i�--P�----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - --------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed} r� l � v----/- ---- --- - --- ---- ----- ---------------- ------------------ ---�r Contractor) By:----------------------------------------------------------- -- ----�U�----------------------- -------{Title) �11/ i �------------ -------- --- ---------- (Plot plan, showing size of lot, location of sy in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ----------------------------------------- DATE------ - REVIEWEDBY -- -- ----------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------- - - DATE �-- --- ---- - ---- -------- Alterations and/or recommendations:------ -L-r -Q ��-------�" ---�f -�-r-- � -•-•_------•--------------------------------- --- ---------------------------------------------------------------------/f----------------------------------------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:-----C--�--. --- _i'• [e Date- -/14 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.