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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) Date Issued �L.... --------------------1/....... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct nd install the Cir ei described. This application is made in compliance ith County O 'nance No. 549. JOB ADDRESS A /� RATION -ter: 1- '--� f�/ - ' Phon /Owner's Name--- Z �- •.... - ---- ------- --Address-----;.� --------- Contractors Phone. Installation will serve: Residence art ent House ❑ Commercial ❑ Trai er Court ❑ Motel ❑ Other ❑ of living units: ---L Number of bedrooms _umbe�Depth hs ____ '"size _____________/_._�...�: ------------------------- Number Water Supply: Public system ❑ Community system ❑ Private to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay ❑ Adobe Hardpan 0 Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes E] No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu ic�sewer is available within 200 feel- _ j --------------- Septic Ta . " Distance from nearest well5_G:-.---__Distance from found .. Material• 4'?1 nd tion_ No. of compartments_--_��---------Size-_!L�,?C_{j---_Z squid depth__J_76_-�--------Capacity....!___Y Q Disposal ' d: Distance from nearest well. -----Distance from foundation..../.-_.---..Distance to nearest lot line.... Number of lines________._.. ____________ _____Length of each line----- �_.�_.-___----_.Width of trench�.9�!-----_.---___�.. Type of filter material -Depth of filter material-------1-�-------Total length------_-------- -.�5 Seepage Distance to nearest well---- _49Q_!.-Distance rom oundation.....__.J��,.(..Distance to nearest lot line____.----- Tj Number of pits.--I-.--_-.._--___-Lining material__�_0.CJ�-_-_Size: Diamei�e'. _1.__--Depth- ------------------ Cesspool: _ _______________ ��Y 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-___--.._-___------___-_-----.----._--_--. ❑ Distance to nearest lot line---------------------- •---------- ----------- --------•-•----------------•----------------------•---------------------_------_------ Remodelingand/or repairing (describe):--------------------------------------------------------------------------------•--------------...................................................... --------------- ----------------------- ------- •---------•-•-------.----- �C ----• -- -----------•--------- 6 -- --------------------------------------------------------------------------------------------------•---------------•--------•--------•--•------------------•-•------------------------------------------ -------------- I hereby certify that I have prepared this application and that the work ill be done in accordance with San Joaquin County ordinances 1 s, and les and re ulati of the San J quin Local ealth District. Contractor (Signed / (�M'r+ ) By:------------------------------------- (Title)--------------- ---•------------- ---- -- ------------- (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_..._ _._ ___ 1�--------- -- ----�'�`-='=---------------------------------------- DATE------�------��--'='---1-•------------------- REVIEWEDBY---------------------------------------------- ---- --------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------- -k------------------ DATE---------------------------•-------------------------------- Alterations and/or,recommendations:...... :--------- -r' = 4=`L y` ` ` `=z-c "�' ---- -C'' c-- : ----------------•-------•------------------------------------------------------- r r:`.•-----......•--•-- -------------------------------- -------------------------------------•------- ---------------------------------------- -----------------------------------------------------------------•-------------------------------------------------------------------- ----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- � � -- FINAL INSPECTION BY:.----`'` ---------- ------- ---•--- Date S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.QO.