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APPLICATION FOR SANITATION PERMIT . Permit (Complete in Duplicate) 3 " Date Issued Applica-%n 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 LOCATION . ._.... t_ Owner's Name. , o� �� - -------------------------- ------------------------------------------------ --- '� - � --,--- 1 _ I Address------------------------ �---------.�— ---- -- Phon --- ------------- ---- - -- --- - Contractor's Name_ ' ---------------------------- Phone----A2..-2-.7,0 . Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-/__ Number of bedrooms _. �1 . umber of baths ../--- Lot size _fir?_-rte_•/-,Il r Water Supply: Publics stem y ❑ Community system ❑ Private Depth to Water Table t;1--- ft. Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam E] Clay Loam E] Clay El- Adobe and an Previous Application Made: Yes [] No �ew Construction: Yes ❑ No ❑ p O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic k: Distance from nearest well_---------------Distance from foundation------------------- No. of compartments--------------------------Size Material -•----'----------- ------------Liquid depth-------------------- ----Capacity--------- sal�ield Distance from nearest well.__--..-__ -Distance from foundation--------------------Distance to nearest lot line----------------- Number o{ lines-------•------------------------ -Length of each line Width- Width of trench------------_-- Type of fitter material-------------------------Depth of filter material-----------------------Total length---•---•---_--- i Seepage Pit: Distance to nearest well--_� .-.�_..--Distance f f�u dation_ , --- Dist rice to nearest lot line.. ..-d____• r p Number of pits..._ -__-.________Lining material..- -_. . _ ..Size: Diameter--.._. ._ � [u Depth_�0---------------------- 171 -- - Cesspool: Distance from nearest well_..............Distance from foundafiion__....-.-..__..___.Lining material__ ❑ Size: Diameter---------- ------------------------ --------- -------Depth-------------- -------------- --------- -----------Liquid Capacity------------- ------------gals. Prrvy: Distance from nearest well '` _ ' -------------------_-..__.-Distance from nearest building------------------------------ Distance to nearest lot line-__-.___--___----------------- - - - -- Remodeling and/or repairing (describe):------ ---- r -•---fir- -•_... ----- P PP ---- ----------- • --- ---- -- ---•-•----- - ----- ----- ----- - - ------ I hereby certify that I have prepared this application and tha+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY$ NIGH' (Signed)--------- ••--Septic--Tank_Swvice------ 7206 So. Eldorado HO 2.704 �_ 4 � `-'""--------------------------- Contractor)BY: -------Stark-tor�;Ct�tif: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - (Title)------ [A)- -��f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.------.------- DATE REVIEWED BY ...... 30) f.... r. BUILDING PERMIT ISSUED-_.._..______________________ - DATE ------�-�------��-------•--------- ---- ---------•--------- - ------ ------ -------•---- DATE------------------------- and/or recommendations:._- - ; ------------------------ ----------------------•- ----------------------•---------•------------ -----•------•-----------•---------------------- .� I ---.-----------------------------------" ---------- ----- --- ------------ - !... . -. ...,.�._ FINAL INSPECTION BY------------- 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 E-"-+�9-2M iasgas aT woon iZ.sq +