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'r -FOR O�F.ICE.Li$E: _._______. ---------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. __l _,;-77 - ----------------------------------------------------- -- (Complete in Duplicate) ______________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. iTh+is application is made in compliance ith County Ordinance N . 549. 2 _f� R S_ JOB ADDRESS AND LOCATIO _ ` Owner's Name. Address------------------ -- ---=Z-5-G�- ..• •-- Contractor's Names Phon -!A `a`�Q..l / Installation will serve: Residence �A arfinent House Commercial Trail r Court Motel L(� p ❑ ❑ ❑ e ❑ Other ❑ �. Number of baths Lot size .___ _�.1�__•�__ __cQ____________________ Number of livingunits: _ ____ Number of bedrooms _ OO Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table --#�--_ ft. 'I Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................l No New Construction: Yes No ❑ FHA/VA: Yes ��o El TYPE-OF- INSTALLATION AND_SPECIFICATIONS. - - - ,� - (No septic tank,or_cesspool permitted if pu6lic.se-wer is-available within 200 feet.) Septic Tank, Distance from nearest we€I ].- -_..._Distancffrom pfou tf}on_-f�_ _._._..Material ' __________________ _________________ No'. of compartments--?------------Sizefr�__ Liquid depth__.._._______________Capacity____ f_1 s- r Disposal d: Distance from nearest wel6;5-_cP......_Distance from foundationDistance to nearest lot li e._--__ ___ Number of lines_____ Length of each Width of trench..._c > . ................ x Type of filter materi __Depth of filter materiaL �f_ '°'"--Total length_'_____1_�Q_�___________________ � t Seepage Pit: Distance to nearest well------ I-____---------Distance from foundation------------.------Distance to nearest lot line-_._.._______.__ r ❑ Number of pits---------------------`!Lining material-----------------------Size: Diameter-----------------.-----Depth_____._--------------_----------.- Cesspool: Distance from nearest well ________________Distance from foundation--------------------Lining material _..___....___-:___.________El ____-_-. iDepth � r ` Size: Diameter___________________ ..___De th__-_-____ _____________Liquid Capacity ___________g aIs. Privy: Distance from nearest well_____._._..______________----------------------Distance from nearest building-'- .---------------------------------- � ❑ Distance to nearest lot line-.------------- ------------------------- ---------------------' r Remodeling and/or repairing (describe):--------------- __________ _____ ____________________ i ------------------------------------------------------------- ts ---------------------------------------------------•------------------------------------------------}----------------------------------- I � ` l I hereby certify that ave prepared this application and'that the work will bei-d'one in azcordance with San Joaquin County ordinances, State lawws, Qp les and regulations,of the Sa_n.Joaquin Local Health-Disfrict. eLJar� C9 �at�hL (Signed}------ --__ ------------- --------(Owner and/or Contractor) 'uEPTfC.-TANK SER'1 ICE _ %: - - _- ry -- ,.. -� RY� 2915_E,:Miner,Ave.,-=.Ii0:fr3841:--------------------- (Title)-------------------------- r ----- - - ----- .... (Plot plan, showing size of lot, location of system in rely in #o wells, buil mgs, etc., can be placed on reverse side). g. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ r R-_ `------ -------------------------------------------------- ------ DATE--------/0r----2_ '--- 5 I REVIEWEDBY-------------------------- ----------------------------------------- ------------------------------------- ----------------- DATE-------- -------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------- ---------------------------------- DATE Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------- -•----------------------------•------------------- --------------------------••------------------------------------------------ ----------------------------- --------------------------------------•--------------•---•------------------------------------------------------- ------------------------------------------------- ------------------- -------------------------- ------------------------------------------------------------------- ------------------------------------------------------- ---------------------------------:---------------- ----------------------------------------°=--=.-•-------- -------- - ------- - ----- -- ---- ---------------------- ------------------------------------------------------------- - -- -------------------------- - ----------- - - ------------------- - ------------------------------------------------------------------- • � 7 I FINAL INSPE' --- Date-- ~' / SAN JOAQUIN LOCAL HEALTH DISTRICT ; l 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0O3