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V FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -12 --------------------------- -------------- [Complete in Duplicate) Date Issued ------------ A This Permit Ex fres 1 Ysar Fram Date Issued 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. qq 1 ---------------- ------------------------ JOB ADDRESS AND LOCATION------__1-�--�- �------ 1 1--------G.�4�-'L--- - ------------------• -------- Owner's Name- dTL------ -- --- Phone - Address 1- ---------------------- -------------------- -----••----------•----------------••-------- Contractor's Name--------- w e - -- - ------ ------------- Phone.- ---�6�--- --- r�--� ❑ ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Motel [ii' Other ❑ Number of living units: __4�0_ Number of bedrooms -4-- Number of baths -_�-_ Lot size __ t� -.-- -.- -Water Supply: Public system F-1Communitysystem El Private Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'E] Clay Loam ❑ Clay ElAdobe [Ei--Tiardpan ElPrevious Application Made: (If yes,date_.---------. .. --) No F1New Construction: Yes ElNo FHA/VA: Yes ❑ No El_ _ TYPE OF INSTALLATION AND SPECIFICATIONS: 6 (No septic tank or cesspool permitted if public sewer is available within 200 feet. epti Tank: Distance from nearest well_________________Distance from foundation--------------------Material__..--------------.------.---------------------.- � No. of compartments----------------------- --Size---------------------- ---Liquid depth------------ -------------Capacity---------------------- , isp I F. d: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line_______-.__._____ Numberof lines Length of each line -Width of trench. ------------ l Type of filter material--------------- ---------Depth of filter material-------------------._-Total length-----------------:------------- • r A + Seepage Pit: Distance to nearest well_.04.__._-..._-Distance om foundation__ S.4-------Distance to nearest lot line--- R..S.... Number of pits-----./------------Lining material-- Or ---Size: Diamefer._��- ---------Depth----o9S-------------------- ,Cesspool: Distance from nearest well_______________ Distance from foundation---._-------------.Lining material-------- ------------_-----__.______ ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals, ' Privy: Distance from nearest well-------------------------------- ------ - Distance from nearest building--------------------------------------- -- ❑ Di -- --------------------------------------stance to nearest !ot line_______________________.--_-__-._______-. - S_Tlq Remodeling and/or repairing (describe):-- ---� - -�-d----------� -----. --------- f-------• -�--------------------- - ------------------------------------------------------------------------------------ - -----------------------------------------------------•---------•------------------------------------- ---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance.with San Joaquin County w -ordinances, State laws, and rules and reg ,l tions of the San Joa yin Local Health District. Ll r Contract (Signed) --- --------------------- ----------------{Titleer an r wn d/o or --- ---- ----- ------ - ---------- ------- By:--------------------------------------------- - P I (Plat plan, showing size of lot, location of system in relation to we s, buildings, etc., can be ced on reverse side]. FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY_ -�e------------------------------------- DATE------ r?�---- —--------------------------- REVIEWEDBY----- ----------------------------------- --- ----------- ----------------------------------------------------------------- DATE_---. --------------------------------------------------- BUILDING PERMIT ISSUED------------------------- - D T -- E----- ----------------------------- ------- --------------- Alterations and/or recommendations:------`f --y--- 2S ........ - -------- - -------------- ------------ ------ ------------------- ----------------- -------------------------------------------------- ---------------------- t. [,� i .---------- - -------------------------------- / �� FINAL INSPECTION BY .-;_ -- ------- --- - ------- - - Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,Cclifornia F.P-Ci1.