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FOR OFFICE USE: ftp„ 94-,e5n,<0-- ",4 - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .�_r __1czz.� --------------------------------------------------- -- - (Complete in Duplicate) Date Issued .,7,,:,?.....r-,112 --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an nsta work here scribed. This application is made in compliance with County Ordinance No. 549. 1aL JOB ADDRESS AND LOCATION.. ,.,.r------1-4.3--` �� r 1` � 1 ---------------------------i Owner's Name y,E' ----------------------------- - . - Phone.. Address--------------- �16� ------a---=-------- --------------•----------------------------------- ContractorsName----- --------------••------------------•----•---•----------•----------•------ Phone.........................--•-••--- . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. Number of bedrooms .__. Number of baths--_ Lot size . - Q___.l-------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table`07*ft. e Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam J;. Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_----------) No R90'New Construction: Yes ❑ No 49--FHA/VA: Yes ❑ No4�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ,T'an Distance from nearest well-----------------Distance from foundation--------------------Material_--____.-------.-__--__-.._----___--.-.._____-_-. No. of compartments ------.--Size-------------------------------Liquid d -- epth_.--------- -------------Capacity----------------------- Disposal Fief Distance from nearest well-------.---------Distance from foundation__________________.Distance to nearest lot line................. $� Number of lines-----------------------------------Length of each line------------------------------Width of trench-------.------ __-__-------_---___ Type of filter material-------------------------Depth of filter material--------------.--------Total length---------._--..____--_--_______--._.--__.- Seepage Pit: Distance to nearest well----- --.--_Distance f orn fQundation_/A_.or.__..Distance to nearest lot line_.._.__._. ��j� Number of pits__.____-..___._.-.Lining mate rial._�©4O. ----Size: Diameter�X�XA00epth_�-__-________________ Cesspoolll: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.------------------------- Size: _:-__- _.---.-___----- Size: Diameter----- -----------------------------Depth--------------------------------------------------._Liquid Capacity---------------------------gals. Privy: Distance from nearest well________________________________ ..Distance from nearest building_______.-_.-_.---__--_-_.-.____...----_.-. ❑ Distance to nearest lot line----------------- -------------------------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------- _6--------- 10--.1114 -------------•-------------------------------•--------------------•---- -------•---------------------------•---------------------------------•------------------------------•------•----------•--------------------•--------•------------ ----------------------------------------------------- . t> --------------------------------------------------------------------------------------------------•-----------------------_..-------------------------------------------------------•------------------------------------- -- ----------- ------ -------------------------------------------------------------•-------------------------------------------------------------------------------- ---------------------------------------------------- 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)------------------------(T _ .... � ---- --- -------------- ------------- ------ or Contractor) ----- - By:--------------------------------------------_ --------- --- - ---------------------------(Title) (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6 ---- -- ----- DATE ----------------------------- J�'_ �"w? REVIEWED BY-------------- -- ------------ - -------- DATE BUILDING PERMIT ISSU ----------------------------------------------------------------------------------- DATE. Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ---------- ------ -------------------------------------------------------------------------------------------------------------- - --------- FINAL INSPECTIO BY:.- ------ ----, - ------ Date--- ---------2:791-6-9------- --------------------- ---------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.