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FOR OFFICE USE: " ---------------------- ---------- ------------------ --------------- - ---------------------------------- ------- ---------- ----- ------------- APPLICATION FOR SANITATION PERMIT Permit No. _12-1.-3........ ---------- --- --------------------------------------- (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires I Year From Date Issued 02? - 0-S'OrrQ Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins+a l the work herein described. This application is 'made in compliance with County Ordinance No. 549. o 4d " e JOB ADDRESS LO ATION_,W _. a� '`- Owner's Name t,_-------- Phone Address--•-.--.---I ��- � ------ °^'� � r 0 j Contractor's Name---- �` � _ --- -------- - --- -- - ----•----•-- Phone... ----....----------•------------ Installation will,serve: Residence 9" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: t---- Number of bedrooms _'7'_-Number of baths __.C___ Lot size _________________ ____ __________._.__._________.____ i Water Supply:° Public system ❑ Community system ❑ PrivateDepth t Water Table -------- ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date..----- --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ -TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public"sewer is rivailable within-200-feet.) Septic Tank: Distance from nearest well--------- Distance from foundation--------------------Material------------------------------------ ___...__.._. � No. of compartments... ..Size--------------------------------Liquid de th--------.-.----...-_._.__Capacity - Disposa:Field: y Number of lines-------------- - _---_--.-___ ___Len th of each line----.-&L?--- I __.Width of trench-.�.-----------�'______ r Distance from nearest well Y--Distance from foundation L?-_____.Distance to nearest lot line__ _ 10 Typeiof filter material_.-_.� ,______De Depth of filter material----. 9__`_ -------- P Total length lut7 - ------------ -- 1 Seepage Pit: Distance to nearest well------ ---------------Distance from foundation------------------- Distance to nearest lot line___.___.___--.._ t ❑ Number of pits----------------------Lining material----------.-----------.Size: Diameter------------ ----Dept h---------------------------___.-• r Cesspool: Distance from nearest well--------------_-Distance from foundation------.-------------Lining material-----_------------------------------- . ❑ t Size: Diameter_-----_-- - ____.De Dept --------------------------------------.-_-_-___-_...Li uid Ca acit- Pq Capacity - ----gals. � Privy: _ i i, Distance from nearest well _Di ________________________________________________ stance from nearest building--------------------------------- -------- El .. tib , _. .,. �� ----------------------------------------------------------------- - - ------- `"Distance near se t iof"line----------------------------------------------- Remodeling and/or repairing (describe):--------42-5t!--:01--"----- ------------------------------------------•------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------•------------- -------------------------------------------------•------------------------------------------------------ ---------------------•--------= -=--------------------- --------- -------------------------------------------•---------------------------------------------------------------------------------------------------------------------------I---------- ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance fwith San Joaquin County ordinances, Stet laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ------- - -•---- - - --- --- - - --- ------ ---- - -------------------------. °mar and/or Contractor) ._ ---------------------------------Title BY: -------------------------------------------------- { )--------------------- ---------- - ----- -- - ---- -------- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed an reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- -- --------------------------------------------------------- DATE J/e,�J_ . - ------------------ ----------------------- REVIEWEDBY------------------- ------------------------ ------------------------------------------------------------------------ --.--- DATE------- ------------------------- --- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------. DATE------------------------------------------------------------ i Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------•--------------------- ------ ------------------------------------------ ----------------------------------------------•-------•------------•-----------------------------------------------------•--•---------- i . ---------------------_.--------.__............-----------------------------------------------------------------------------------------------------.-----------------------------------------.___-----------_----------------- -...............................a_-.-...-.--.-.------.-----________-__-.....__......-._-_.-.._._..__--_._..___.-_--_____.__.__...._.._________..._______._-...______-.-..-_---___..._-_--_____.._________.._._._.____.._.__.-- FINAL INSPECTION BYl/� x'19--------•----------- Date- �� -------- 6------------------------------- --- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.