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FOR OFFICE U I Permit No. .....___3_. `� --------------------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Com le+e in Duplicate) `-0` it --------------------------- -------•-------------------- jf P P } Date Issued ... - } --- "' -This.Permit Expires 1'Year From Date Issued - i Application is hereby made to the San Joaquin Local Health District for 6 permit to construct and install the work herein described: This application is made in compliance with County Ordinance No. 549, f ` c JOB ADDRESS AND LOCATION____ _____________ _ -------------•-•--•-- -- -- - ' Owner's Name------------ s� G/ - � • - -- --- -------- - - - -- - --------- -- ----- - ---------- ------ Address -------- --------------------------------------- ---� ---- � a ----- Y�r Contractor's Name-----�--------------- GG , ---------__--__ Installation will serve: lResidence Apartment HouseF❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: __I__ Nurnber of bedrooms_ �P_ Number of baths ._ - Lot size ____-, __.__�4/.�`��__________________ Water Supply: Public system �ommunity system ❑_ Private ❑ Depth to Water Table ft. 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 Yes El No 1z1._.�--+ . � r TYPE OF INSTALLATION AND SPECIFICATIONS:.. t r (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) Septics Tan - Distance from nearest well-----------------Distance from foundation----------------------Material---------------.--------------------------------- No. of compartments--------------------------Size-----• ------------------------Liquid depth--------------------------Capacity-•-----•------- Dis osal Field: istance from nearest well______ _ ______ _Distance from foundation../d_.._..'___.Distance to nearest lot line._.-___________ p j- s Number of lines______i______ __r______-Len:'Length of each line_____s Width of trench.__ l`,_______________ 9 i �1 , Type of filter material_V__4iC.k-:----_Depth of filter material---1_ ______?____Total length____ _ ------------------------- Seepage _____ __________________Seepage Pit- Distance to nearest'well_ 5_C-------------Distance from foundation')_I?---------------Distance to nearest lot line---,S---------- 14y [�o _ _ _ ______Lining mate Depth _________________.___Number ofpits_______ __ e , t Distance-fPc rn-nearest well---------.____-Distance from foundation--------------------Lining material-------------.-______________-_____. ❑ Size: Diameter -------------- ------Depth----•- Liquid Capacity gals. Privy: Distance from nearest well----------------------------------------------- _______________ ___________________________`._•Distance from nearest building__--___-_____________________._____--.--. ❑ r ` -- ----M,. -- ---- -- - --------- 4 --------------------------------••----'--- s ------- Distance to nearest lot line____________ _____________- _____ _____ __ •-- Remodeling and/or repairing (descrri e)--------------------- ._. t i - •------ ------ --- ` ------------ ------------------•`------ --------------------------- ----- --------------------------------------------•------------`------_____---..-------'----^----------________-.__--s--------- I hereby certify jthat 1 have prepared +his'applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and r gula ions of the.San Joaquin1o"C' l Health District. ' Y = - (Owner and/or Contractor ) ` ---------------- -- ------------------------ (Signed)----- -•------- t 141(Plo+'.plan,.showirig lot, location of sys+em in rela to Ils,'buildings, eft can be' placed on reverse side). FOR DEPARTMENT USE ONLY, ' ---:-- --- -{--- ----- -----�------•------------ ------ DATE--------- r..... '- - ,aa ,, --------------- APPLICATION ACCEPTED BY__._ BUILDING PERMIT ISSUED -----= --------- _ ?- - : DATE REVIEWED BY-------------------------------- --- = i'----------------------- DATE-•--------------------:_...--------------------- •---•- Alterations and/or recommend ns:__ .� - --------- --•- ---- -------------------------------------- . ----------------- ----------- - _ ....--- ` _ y( 7-- ---��r - :----------•ted-L!_...�, `" ---- -••--------------------------------------------------- ---------------------------I-------------------------. --•------------- -------------------------------- -----y----------- --------------------------------- ---- ---- - • r -- - --- ' ---------- -- --- - ------------------------------------------------ ------- - •---•-----._--- ----------- - i r - - - - - - `- - FINAL INSPECTION BY l �` - - Date ----- -- ---- ---/---------------- fl{ (,w_SAN fJOAQl1_IN FOCAL HAEALTH DISTRICT 130 South America'n Street300 West Oak Street 114 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Traeyr California E9.9 AMOCO B-59 F.P.CC,1M 6.613 - F