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R OFFICE USE: . _ ------------- ------------------------------------ ---_ ________ APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ---- - ------ --- --- ---------------- (Complete in Duplicate) $f Date Issued ------------------------- ------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healt District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. JOB ADDRESS AND ATION... C � - �- LC' G > - Owner's Name = -- -- --------------------- - P - ------ ' y--Y Address �"�--_� ------:;ter-.- -----••-• ------------------ Contractor's ---------- -------- -:Contractor s Na ------•- � '.--- -=--- ----_--•------- -•-----•--- Ph ------��_�J_- __._ Installation will serve: Residence jn�,par-tment ouse ❑� mmercial ❑ Trailer Court ❑ Motel E], Other .y Number of living units: umber of bedrooms -__ __._ Number of baths _fi---- Lot size ._._ _ -d-- t Water Supply: Public system ❑ Community system ❑ Privateep to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay o Adobe Hardpan ❑ Previous Application Made: (If yes,date_----.__,_,--------) No ❑ New Construction: Yes ❑ No K4--fF 1X/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_________________Distance from foundation__._______________Material____--._.--________________-_________--.______- z No. of compartments-------------------------Size--------------------------------Liquid dept Capacity------------- po l el�� Distance from nearest well-4-L_ _ _ Distance from foundat•on-_-______Distance to neares to line----�- Number of lines_________ ___ ________ _ _ _____Length of each line___}�_ ____.Width of tren � -----__1____-__ Type of filter mater _ p g �.� _ ____ _____De Depth of filter matenal____._,C Total length . Seepage Pit: Distance to nearest well____________________Distance from foundation--------------------Distance to nearest lot line_______-_________ ❑ Number of pits----------------------Li • g material-----------------------Size: Diameter----------------------.Depth--------------------------------- ❑p l: Distance from nearest well-_______________Distance from foundation--------------------Lining material--.-____-._-_____._._______-_____-___. r Size: Diameter------------------- ---.-De th----_--------------------------- -------Liquid Capacity gals. r Privy: Distance from nearest well________________________________________________Distance from nearest building-____-._________________-______:__-.___. ❑ Distance to nearest lot line_____________________________ -------------------------------------------------------------------------------------------------------------- Remodeling and/or repairi g (desc 'be�:- �`' - =------ - • � -------------------------------------------------------------- -------- -------------------- -------- - ------------- --- ---- ----------------------------------------------------------------------------------- ------ - ----------- '` --------- -------------------------- ----------- ------------=-------------------------------------------- ! hereby cer i _th have "prepared this applicatto and that the work will be don accordance with San Joaquin County ordinances, S avis, an rules an egulations of th San oaquin^Lo 1 Health is i {Si ned ----- ZW --- ------ --- -- 9 IL-Ift�Contractor) w i By--------------------------------------------------------------------------------------- -- .. ------- ------(Title)------ -- ----"-------------- ----------------------- (Plot plan, showing size of lot, location of system in relation f ells, buildings, etc, can be placed on reverse side). I FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----------------------------------------------------- ------ -1--- DATE------- 15-12 � ----------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------- --------. DATE-------- ------------------ BUILDING PERMIT ISSUED---- ----------------------------------------------------------------------------------- -------- DA•TE-------- ------------------ - 0 Alterations and/or recommendations----------------------- ------- --- - --------------- -------------------------------------------------------------------------------•-- ---------------- ---------------------------------------- „==---------------------------••----------- ------------------------------------ - -------------------------------------------------------------------•----------•-------------------------------•------------------------------ -------------------------------------------••--------------------------•------------------------------------------------------------------------------•-----------•----------------------------------------------- ------------------------------ -- --------- ------------------------------------•------------------------------------------------------------------------ ----------- --------------------------------------- FINAL INSPECTION BY: /-V- rAN 'G � -1=_ Date .. `/ / G y ---- OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California M 9 REVISED 8-59 3M 3•'63 F.P.CD.