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ld _ APPLICATION FOR SANITATION PERMIT Permit No. _65?%-2 l_____.. lI (Complete in Duplicate) f t 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. p JOB ADDRESS'AND LOCATION__R_-t_,__q--- 4X---(+ ;M--e- i�--------------- _L .------- , ----- Owner's N me---- - _ � • -----------•- •-----------------------------;------ - ---------- ------ Phone.-�'�"_�1-----c �60 / Address -Q_ __ �_ -------- -_Q _Mia A/ . � ---- Adc _Q_C ---------- A//. T- Contractor's Name__ r -,� -j - a: _V_! -•---------------------•---------- ------------ Phomal.��7 b l ----------- Installation Installation will serve: Residence [Apartment House ❑ Commercial El Trailer Court E] Motel E] Other ❑ Number of living units: __�__.__ Number of bedrooms _�_ Number of baths 4___ Lot size _____________ Water Supply:- Public system ❑ Community system ❑ Private �pfh to'Water Table .------- ft. Character of soil to a depth of 3 feet:i Sand ravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe Hardpan ❑� Previous Application Made: Yes E] No New Construction: Yes ❑ No HA/VA: Yes ❑ No 5;-- TYPE ;— ---TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) D�s ance from tic T nk: Not of-compartments} well---__ _ --- izeance-from foundatiL"quid depth_-Material---------Capacity___ ____._______-- D" posgl I Distance from nearest well.4_01- &0 Distance from foundation___.__ J.0_____Distance to nearest lot line______-... Nof"lines________________�.__._____' Length of each line------ _ fi_--.Width of french----;- umber �______..____ }� Type of filter material_5_�_+ A_ Depth of filter material--___/_ .______-_Total length._------- - - 5iv Seepage Pit: Distance to nearest well______ _ _______ ______Distance from foundation----------------_--- _Distance to nearest lot line--------.__.___._ ❑ Number of pits------ l -------------Lining materia-----------------------S;ze: Diameter-----------------------Depth---------.-----_----------- ---- Cesspool:, Distance from nearest wall------------------Distance from foundation--------------------Lining material_____--__---_------ -_-__________ ❑ Size: Diameter Depth = -----------------------------------Liquid Capacity----------------------------gals. Privy: _t. Distance from nearest well __----------------------------------------------Distance from nearest building-------------.___-_-----_---------_-----_. ❑ --- x ----- ------------ DlStanCe t0 neareSt'10t l�lne------"'=`�� ate..•a.,-raw-�� -------------------- ----------------T--------------------------------- /------------:------ Remodeling and/or repairing (describe):-__-_-.___--- --•__---_ � ---- ---._.------•-------- -----• ��i - '_1( -- ------------------------- �. ' - ,---------•------ .•-•---- --------------------------------------------------------------------=------------ _, ..-_--- ---------------------------ft--------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------------------------•------------------------------------- -- .. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaq in Local Health District. f . (Signed) i DAY.&IMIM------------------------------- ! ----- -- ontractor t_r Septic Tank Servies _ ,,�_ gY� ----------------------------- - --- --------------- --•---- - ----- -----` A---(Title) r`� _ ------- ---2�T0 -/ - -- --- [Plot plan, sho 4"te of lot, lob f"11-101 ,� n m relation tot, s, buildings, etc., an be p don reverse side]. FOR DEPARTM NT USE ONLY APPLICATION ACCEPTED BY--------- - - ---------------------------------------------------------------------------- DATE----- --- REVIEWEDBY---------------------------------------------------------------------- ------ DATE-------------------------------------.---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------- Alterations and/or recommendations:---------------------------------------------- ---------------------••-•------------•---•----•-- -------------•---•-•--•-------•--------•------------------- . ----------------------------------- ----- :A FINAL INSPECTION BY:---- _ ------ - --- - ------- Date_--- ----------- ------------------------------------- -SAN JOAQU LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F.P CO.