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FOR OFFICE USE: -------- ----------f_____.______-__.-_____.__-_______ APPLICATION FOR SANITATION PERMIT Permit No. -.12... ------------------------------------------------------------ (Complete in Duplicate) / ! t -------- This Permit Ex fires"1 Year from'Date Issued Date Issued .......... .. ..�l_ 4 -- ' ' 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 o. 549. /� / -------------------------------------------------- JOB ADDRESS AND LOCATIOf� __-. :___-- `_--•-------.... Owner's Name-----I-4 j- Cl . --------------•--•-•••-------------------------r--------- -----------------•----------------•--- Phone------------------------------•---- Add, -----•---•----•--- ---' t f _ --•---.-- I -----------------------------------------------------------•.._.---------.-- h de--•--------------------•--------•-- lnstallationr will serve: Residence .:'A artment I"louse � F Phor{e___________________________________ • 9',, ;P ❑ Commercial ❑ Trailer Court ❑ Motel ❑ -Other ❑ Number of.livin unitsi _-/_";Number of bedrooms_ Number of baths ----•---------------------••- g ---- l,� Lot size - -•--- Water»Supply: Public system '❑ ' Community system ❑ P'rivateiZ40"IDepth to Water Table /&?f. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,cfate---.--------_--------I No VI-IN' ew Construction: Yes ❑ No. Yes#❑ No gi—I-7— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer.isavailable within 200 feet.) Sejt c Tank-, Distance from'nearest well-----------------Distance from foundation___:_._______=._-_.Material-.-_--___._._-_-________.__-_-__________.____--. ,Wls�//L� . No. of comprrtments- _T___Size------------------------------•Liquid depth_-----:-------------------Capacity---- • r ` ' y'. /� Disposal F �d: Distance from-nn artist well-_�lc�-:__._.Distance from foundation _ __�___:..-.Distance to nearest I� line ,r /� Number of lines:_______,______ Length of each lineWidth of trench--�-------------T_._______-___ s _ Type of filter material__Depth of filter niatenal_._yl �_-.-dotal length____ ----------------------------- Seepage ~�____'______________ .�..-- - +t. •... l - i_ . I w. .Mt . Seepage Pit: Distance to nearest well-_____________________Distance from foundation:__.______-:__::___.Distance to nearest lot line_-__--_--________ ❑ :Nuamber ofdpits- -----------------_Lining material---------------,-1-----Size: Diameter---------------------- Depth----------------------------- Cesspool: Distance f" nearest well--------------___Distance from foundation--------------:-___Lining material------------------------------------- ❑ Size: Diameter. ----`-------------------------- Depth----------------;--------------------------s---Liquid Capacity-------------------------.--gals. Q Privy:: Distance from nearest well_______________ _____i.-_-___---------_-___-_Distance from nearest.building----------------------:_______._____-__-_ Distance to nearest lot line-�`"---- ---.---- -- "---- Remodeling.and/or repairing ( escribe):------------------' == f ��- - --•------------------------------------- ----- •----•---- --- -- --------- -------------------------=------•---•-----•-------•--------•----------- f...'� ---------------------------•-------•-----..------•--------•------------------------------------•-----------------=-------------..----------------------------------- = -------------------- I:hereby certify that 1 have prepared this"appli�tion-and that the work will'be done in accordance with San Joaquin County ordinances, State laws,'and rules and-, egulations /A a San Jaaq n Local Health District. 1 (Signed)•----•--•------------- -- - ------ ---------- --------- '�r Contractor) t { i r + r ( By:------=------ ---....-----...- - � = {Title) - (Plot plan, showing siie of.lot,�Focation of system in relation to w ells,.buildings. etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY_____ .r__ a-- �. DATE.. --------------------- REVIEWED BY -'------------""- -------------- DATE- -------------- BUILDING PERMIT ISSUED-- ---- --- --•---------------------- -----------------------------------_- ..__.. Df4TE----------------------=--------- Alterations and/or recommendations_ -- ----: - ---------------------------t --------------'---•----•---•---•-•----------=----------------•=--------•----- ------------------------= ----------............ ---------- -----------------------•----------------------------------- --- ----------- - --------------- -------••- --------. I.. _____________________________________________________'_____. -�_ ------ ------ --- - -------- ------ ---------------------------------------------....... ---------------- .........._•_•----•_•---•----------•_-•-••----•------•---------------------------------------- I Y F FINAL INSP ?N-BX---- -- '— / �. l .��-• - ------ ----------- - Date"------------------ -----.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street E, Stockton,California Lodi,CallfornI., y Manteca,California Tracy,California E9.9 REVISED 9.59 F.P.CO.ZM 6.60