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FOR OFFICE USE: -----_-------------------------------------_---_------ APPLICATION FOR SANITATION PERMIT Permit No. /_4�__ --------------------------------------------------------- {Complete in Duplicate} Date issued l=_/-___�� _____________________________________________ This Permit Expires I Year From 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. JOB ADDRESS AND CATION_____d4._ + - - Owner's Name------ ---- --------------- ------ ------ ------------------- Address --••---;-- - Phone_ �- ,Z,2{ Address-------------- ...e_ ,_ - / 1 U ior Contractor's Nam�l__. -' �V-- _. ---- - - -- ------- - _ ro -- }------------------ Phone y_ _ ---------_-_- Installation will serve: Residence Apartment. Ouse ❑ Commercirailer Court ❑ Motel ❑ ther ❑ , Number of living units: �_ Number of bedrooms Z-_- Number of aths _ Lot size -- --- _ .___-___-_______________________________ Water Supply: Public system ❑ Community system ❑ Private - Depth to Water Tablebp_ ft. Character of soil to a depth of 3 feet: ISand ❑ Gravel F] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ 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 available within 280 feet.) , Se nk: Distance from nearest welf------_---------_'Distance from foundation__-_____--__...____-Material----------------------------------------________- No. of compartments---------- ---------------isize--------------------------------Liquid del?tk--------------------------Capacity------------ ---nq------- o a field: Distance from nearest well_ p.-_---'Distance from foundation_____lQ---_-Distance to nearest lot line__`___... "Number of lines________ .__ _�_-___ lLength of each line_��41_________Width of trenchA.!�_��--If-------*-___ „ .� yp __ Depth of filter ma rial___�_��_.-___ length d T e of filter matari�l . _ ___._Total _________ �_________________ Seepa e Pit: Distance to nearest well_-/PQ*._______:€Distance frog�}} foundation___IQ.._____-_.Distance to nearest lot J Number of pits-_I-----------------Lining material_ ocl ------- size: Diameter_ ..Depth_-_---�,zr_-------------- Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material-------------------------------------- F-I Size: Diameter--------------------------------------Depth 7--------------------------------------------------Liquid Capacity---------------------------gals. I Privy: Distance from nearest well------- __---------------------------------------------Distance from nearest building---_____-_-___-_____-______________-_-_. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------- --------------------- ------- Remodeling and/or repairing (describe):---------------------------__ _ ___ _ --------------------------------------•------------------------------- •---- ------------------- -------------------------------------------------------- - - _ 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,__,4 mules and regulations of the San Joaquin Local Health District. (Signed) �a C� %4P SEPInC TANK SERVICE i �Ya91 -Miner Ave:r--=-tln,- 3 ct� ------- -- -- - --- (Title) - (Plot plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- -----.------------------------------------------------------- DATE------- REVIEWEDBY---------------------------------- ------------------------------------------------- DATE-- ---------•----------------------------------------------- BUiLDINGPERMIT ISSUED----------------------------------------- ---- ----------------------------------------------------- DATE---- ------__------------ Alterations and/or recommend ions:-------- - ------------------- "------------------------------------------------------------------------------------------ --------------- 1I ,�- 6� ------------- E ---------a- f - e -r----- = -------------------------------------- ---- FINAL INSPECTION BY:------ - ------------ Date �� r ---------------------- ----------------- SA JUIN LOCAL HEALTH DISTRICT 1601 F.Ha:ellon Ave. 300 West Oak Street 124 Sycarnore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.cn. .°f