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FOR OFFICE USE: f, 4 --------_----------- .APPLI.QATION FORt SANITATIONFPERMIT Permit No. ... --� '' - ------- ---------------------------------- d�ll _7--------- -- -- --- =V_ (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued Date Issued Applicati'n is hereby made to the San Joaquin Local Health District for; rmit on uct nd inst4tThn erei d wor essc`ribe This application°is made in compliance with County Ordinance No. 549. JOB ADDRESS A LOCA N--- ------- ' -- - ------ - _'_` p Owner's Na C _. r�,1� -^........ --- •w�`•t'- 2.. ti_ .._. Phone--------- Address_ fs:_),_�.... fr y --------------------- -- -�.Dt----- .. . .. f 1- 1------------------------ Ph e.- Contractor's Name___' . ______. _____ ` =t -�' � ,—Installation will serve: Residence �partment House Commercial [❑ Trailee�r Court ❑ } Motel ❑ Other ❑ { �, Number of living units: _�_____ Number of bedroo Number of baths Lkot size._ j_ _ Water Supply: Public system ❑ Community syste ❑ Privateept to W er;Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Adobe ❑ Hardpan ❑ -. Previous Application Made: (If yes,date--- ----------------) No E] New Construction: Yes No ❑ FHA/VA: Yes E] No ❑ ' r TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feette.) �_.�.. � Septic Tank: Distance from nearest ell_,r�_0lDista,nl!c� from�fou �ft'�n___ su_�_._. M ter' I __-- _______________________..__._. No, of compartments::"----'.""'-S,izej/-'�_ 7--Liquid de th_.� _____Ca acit Ae Q_ _A�S' 4 1 { p , AA r f .......Distance to nearest lot line___S� d Dis osal Field: Distance from near weIL.�CF'QLL�'____Distance from foundation.___ ___ __ Number of lines___ ___ _ _.._Lengthsof each,line/OP'__/_ou� '�/Vidth of trench_._.____.cn �r.____ Type of filter material _De tii:of,filter mater,ial____-/ °r -Total len th____ ._.___________---___ r Seepage Pit: Distance to nearest well-----------..---------Distance from-foundation__;,__-------------Distance to nearest lot line------ -_---- 8 ❑ Number of pits----------------_---_Lining material----------------------Size: Diameter----------------- -----Depth-----------------_--------------- E Cessook Distance from nearest well_________________Distance from foundation._.._. ._._ P Lining material t --------------------------------------\ Liquid Capacity_. _-----_gals. ❑ Size: Diameter-}----- R----- Depth-------- -- }Privy: Distance from nearest f " ❑ well...._____ _______ ____ ..._ _._.___ ___ __ Distance fromn'e`rest building_________.__.._____-___------__.___._.__. D '�ne_ _____________�____________..._____._-------------------- istance to nearest lotli Remodeling and/or repairing (describe)____----------------_--------:_ � ' Y i r ---------------------------------------------------------------- --------------------------------------------------- ------------------------- ----------------------- ------ ----------- ---------------------------------------------------------- - -------- -----•-- ------=------------------------------------- ----------------------------------- - _--------------------------------- } I hereby certify that I have prepared this application and that the work will be done in actor ante with San Joaquin County ordinances, State laws, an ules and regulations of the San aquin Local Health District. Si ned ________ a - - --�---------------�----- -- - -- -------------------- - - --- ------ ----- --- --- ------ --------------------- Contractors (Signed) g , ' SEPTIC TANK SERVICE r g 29]15E.A43ner.Auei,a_� Ii0_J5!s JL-------------------------------- Ti . -------- (Plot plan,.showing size of lot, location of system in relation t wells,:buildings, a ., can be placed on reverse side}. I FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED r-�.. - ------- -- ------ ------- ----' DATE c�� 1/_G ------------------------------------ REVIEWED BY ---�"'---------------------------- DATE------------------------------------ BUILDING PERMIT ISSUED------------------- --------------• --------- t ------- ----- DATE_.-- _ Alterations and/or recommendations:------------------ ---------- ---------- ----------------------------------------------"----------------------------------------------------------------- - fes. L ------------------ -------.-----.---------------------------------...__----------------.----- --------------.------------------------------------- FINAL INSPECTION BY:- --- ------- ---------- Date.--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.p.Co. -- r w"i