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�5 PLICATION FOR SANITATION PERMIT Permit No. __ _- �-- AP _ (Complete in Duplicate) pate Issued Application is hereby made to the'Son 4Jo uin Local Health District for a permit to construct and install the'work herein described. This application is made in compliance ounty Ordinance No. 5 e I JOB ADDRESS AN TION / ----- ------ ------ -------------- --------------------'----------- -- ------ ----J = s Y - Phone ------- ----------- Owner's Name_ ^" ------ ------------ .t --------------- --------------- _ . :,:: •r ». -------- - _----��----'---- -- Address__ p Contractors Name__ __-___. ` /} S.7 ---- hon __ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.-E]. Other ❑ Number of living units: _�Numberiof bedrooms :� Number of baths Lot size _-__ �7"-------/--r-0-~---------•- I Water Supply:' Public system'[�ommuriify system ❑ Private ❑'`Depth to Water Table _ v ft' Adobe Hardpan Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El Clay Loam El Clay E3 Adobe Previous Application Made: Yes E] No New Construction: Yes E3No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND iSPECIFICATIONS: = ` � (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4 5 cNo. of compartments----- --------------------Size----•----- ----------=------ati .Material -. . Distance from� nearest well-----------------Distance from foundon_.._.---------�--- ----------- ----------•-- -------•------------Liquid depth-------------------------Capacity----------------------- D sal - Distance to nearest lot l-ine----._-_______._ Distance fromi nearest well______________ Distance from foundation__ ___-___._-,___ --------------------- h of each line Number of lies----- W ------------- nen Type of filter;'material-------'---------------- Depth of filter,material-- `--':" ------------Total length----------.-•-------•--------------------- - Y�rf3i Dist c to nearest 10 line_ !-.. Seepage f: . vDisance to nearest well _L•z-r7_ __Distance undation_ -. Number of pits':__ __ _ ___ Lining mater'sa1 _______..__ ____ .Size: Diameter___ _______Depth_ . ---- --- _Distance from foundation_:_„ __:_:----_ Lining material------------------------------------- . nce froh Cesspool SDizeaDiameter_•ea st--e------- -`---:Depth--=--=------- '= == = `-'-�k�` -----Liquid-Ca pacify----•------- ---------- gals. t ❑ t s r..: aF - Privy. 'D#stance frori� nearest swell--_`---- -- --- -- --- -- ------- -Distance from nearest building----- _---�.�--- ---- ---- El Distance to nearest lot lire"- __ '"—_-- I Ir � TI------ --------- -- ------ Remodeling and/or repairing (describe). '-. -- Ir -- ------------------- I -- --- 'r ;..;. : 4 �4-4 - --------------------------------'I-`------- -- --------- --------•---- --------- ----------------------------------------- --------- auiI hereby certify that l have prepared.this application a ha# the work will be'done in accordance with San3oaquin County ordinances, laws, and ru�l s arvd,r; gu�lons of the S J aqui Local a th District. 1�[i�E'!i a *` : t r Contractor Sepcetic Tank Servi - '.,� ] Si Y�- .=<: - -6 - ( ned 2s 9us: Itioracto iii -7646--- --- By:------°----------------------- t rzktan,-Coma --------------------- - ---- ------------- (Plot plan, showing size of lot, location of system in rela to we ls� buildings, a ., can be placed on reverse side). ` FOR DEPARTMENT USE ONL -� '® DATE- S ATE-----�---•---•---------------------------------•------ APPLICATION ACCEPTED BYE'_____.--___t___ -_ _-- REVIEWED BY------ ---------------------------------- 'i,` - � -x - _ DATE. _ = BUILDING PERMIT ISSUED------------ ------- -------- ---- ----`----------=------------------------------------ ------ . DATE = `., - Alteration and/,pr ec mmead t ions------------------ -------------- A-- -- - ----- 1 i - --. -- -------------------------- FINAL INSPECTION BY:._:_! ` - -------- -------------- --------- Date --- SAN JOAQUIN 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-4-2M Revised 1 S7 F.P',CO.