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r-�U12 UFFICE USE; *- — f/ f1 25 -- --------------------- --------- --------- ------ ----- _--__- APPLICATION FOR SANITATION PERMIT Permit No. .__r1... ------- ------ ------------------------------ ------------ �• (Complete in Duplicate).. - ---------- -------- --- --- ---------- This Permit Ex fres-1 Year From Date Issued Date Issued------- Application is hereby made to the San Joaquin Local Health District for permit This application is made in compliance with County Ordinance No. 549. p to construct and install the rk h scribed. JOB ADDRESS AND LOCATION___.__ I 1_ - € F ----- = 1 Owner's' Name------ �.r97x�qi ? -` - �� ------------ -------------------._. - - •'r - ------------ - - - -Address-------- ------------ ---.....---------------------•--- • - 7-• _ Contractor's Name-----rw s1*. . Installation will serve: Residence ❑ Apartment Hos ❑ Commercial ❑ Trailer -Motel ❑ Other ❑ E Number of living units. Number of bedrooms _7-�Number of baths __/ Lot size -______----f _C� {�Lj . Water Supply: Public system ❑ Community --------------------- system ❑ 'Private �pth to Water Table ----__- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ HardpanAF [] Previous Application Made: (If yes,�ote....................) No El New Construction: Yes No t ❑ ❑ FHA/VA; Yes ❑ No [] (TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 fee+.) Septic Tank: Distance from nearest well----(70----:___Distance Distance from foundation__._ _ C' f Matergai� f --------------------rr No. of,compartments-_.-__--7—.__-----Size_____ _ •+- . �.e , - - Liquid depth---- ---�..-_.-----Capacity--�-------- Disposal field: Distance from nearest well- /-__ "i Distance from foundation._ - - ---_----.Distance to nearest lot line----s��.-- "" Number of lines---------------- -----------Length of each line--- - �� t Width of trench---,_- "� � -7;1- Type of filter material---Xe-� LDepth of filter material____-_ -_ 7f a { f.- ---.Total, length----------- ---------------------- 7_ ~. - y i Seepage Pit: Distance to nearest well---j_ ----Distant fr m foundation__.../.-f_.--------Distance to nearest lot line-_-__-_-----__ ❑-J �? Number of pits-'I------- --------Lining material---- -- - Depth l f f � . Cesspool: Distance from nearest well________.____-_ Distance from fo,ndation.---- --------------Lining material___.____-________.__-----.-_----_- # ❑ Size: Diameter_-:_ -__ .____ ---- �------ --:Depth - --- ------ ---- ------ ---- --- ---------Liquid Capacity-------------------------------- ----------------------•-gals: Privy: Distance from -nearest well________________________________________---------Distance from nearest.buildin g ' ❑ Distance,to Barest lot line ----_ ----_-- -------- ----------------------------- ---- ----- ------------- -- Remodeling and/or repairing {descrii�e) , � - � -----------••----- -- ----- =--- ---- - ---------------- ------------------------ Remodeling ---------- ------ -- ----- -- ------:-- t �. '4 f -= ------- ---= ----------'--------------------------------------------------- - ` --.--------------- -------------------r--------- _ --' ----------- - - - -:: '-- __ - ----------------------------------- ------------------------------- -------•---------------------------- ------ C I hereby certify that I.have prepared this`application and that the work will be done in accordance_with San Joaquin County 1 ordinances, State laws, and rules arid'regula.tions of-the-San Joaquin Local Health,District. � (Signed)-,- x, 1 ' uc 0 } .. � ---------------------- -------------- --------- ---------- O ner and/or Contractor) By:------------------- = j .[j w d/o N ---- -------- _= Plot Ian, showing - - ----------- --- p g size of lot, location of system in relation tawells, buildings, etc:; can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------ APPLICATION ACCEPTED BY_________________ t ''—`� REVIEWED BY — — ---------- DATE- _. --------------------------------------•-------------------- DATE-- BUILDING PERMIT ISSUED-------------- -:----- ------------------------- ------Alterations and/or recomme-dations:----- `_' a DFtTE_.._�---------------- _ - — ------------------------------------ --------------- -- --- -- --------- / —". . - t _ _ ....__- ____ ._ t...._. ��f_.P�r----r- _______________ V�4 _ ._.____ - ___ - __ _ __ = r��------x -- ---=---- --P-.._- - h I C_.<<__� err'-- �. ------------------------------------- ----------=------- ------ --- - ------------------------------- FINAL INSPECTION BY . -•-------; --- Date-- -----G1-- -- ---------------- SAI`JOAQUIN LOCAL HEALTH DISTRICT r 2` 1401 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 285 West 9th Street i Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED S-54 3M 3'%%