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FOR OFFICE USE: ------ le � ----------- �' Via._---------------------------- APPLICATION FOR SANITATION PERMIT Permit rlll�--------- (Complete in Duplicate) v �� Date Issued o-iS,Psr Application- --- is This Permit Expires I Year From Date Issued hereby made to the San Joaquin Local Health District for a permit to construct and install the wo. her iKdescribed. Q� This application is made in compliance with County Ordinance No. 549. 0�c4c:cy JOB ADDRESS AND LOCATION_______ Ph-o-neOwner's Name-------•- - - ---------- ---- 7 --/ -----/--- - Addresg5wz_cl.t ---------- Contractor's Name...C, }--r -[.4.d• _„ -S QQ � - -• -- /1 4.-. Phone__ Ea�_ . 'Installation will serve: Residence 2�partment use ❑ .Commercial ❑ Traile ourt ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms-._1_-- Number of baths __I_�f size _ _ — ------------------- Water Supply: Public system E] Community system E-1 Private De pth to Water Table . /_eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -lardpan ❑ �r Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S015Tic IT &A ' Distance from nearest well-----------------Distance from foundation------------------.Material----.-------------------------------------------- No. of compartments----._ ._.Size---___ q p, Capacity----- ------ - ------------------------ - _ . -' --:---- ---- --------._Ca acct ------ J �- A sposal Ids- Distance from nearest well-7,0-'.r.- Number ell-7.'0... .:_Distance from foundation__:___ _=Distance to nearest lot Ime___1_��__. �. Liquid e _ G � N amber of lines Length.of each lir�e '�'i, Width of trench r- �i�� -------- . CFS Type of filter mater� '1f�--Depth of filter mater al__� ----------..Total length------- -40-- •.------ . � . S ge�s� Distance to nearest well_I_Qo...__...Distance from foundation-__,..?_Q_-_:"Distance to nearest lot line--__/4`:.- `" r �/"�,(N— Number of pits ......... Lining material �` �. � p ��.�—-------- i C'- -. ---._.Size: Diameter. -_-__Depth cesspool: Distance from nearest well------_ Y--____Dista�e from foundation----- =_-_-_.Lining material----------------------------------- # ❑ Size: Diameter----- = *` ------.Depth`-------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------- _____________z:-------.-------------Distance from nearest building__.------- _Y r -- '4 ❑ Distance to nearest lot line----------------- ------------------------------•--------------•----------------------------------------- - ------------------------ _ .. Remodeling and/or repairing (describe)------ ---------------------- --------------- -- --- ------------------- ------------- ---•------------- --------------------- ----------------------------------------- ----------------------------------------------- __________________________________________________________________________________________•___-----_____.__-__-___----__ ---------___-----__ -.---.-__-.--_-_-------_---.-------.._--.----- I hereby certify that ave,prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws; mules and regulations of the San Joaquin Local Health District. (Signed)------ ------� ---- --------__---------- -- - Contractor) .t �EPTI�--'T'P.NK SEF�VICE - - -- - B . 2915 E.Miner Ave., Hb__6.3841.----------------- -------------- Title------ --------- - -------- ----- ------ ------ --------- (Plot plan, showing size of lot, location of system in relation t ells, buildings, a ., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ---- - ---=------- ------ - --- --- ------ ----------------------------------------------- DATE----- ------------------------ REVIEWEDBY-------------------------- -- ----- ---------------------------------- DATE----- ----------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ------------- DATE----------------- ------------------------------------------ Alterations and/or recommendations------- ---------- --------- --------- --------------------------------------------•-----------•-----------------------•-------- •---- ----------------------- /ll- .� y�-r _- - ............ -� — -------------•--• ----------------•----------- ------------------------•- ----- --- --- --•---- -------------------- --- ------------ -------------------- ------------- ------�° /�' -------- - --- .- - ------------- �. - ----------------------- ------------------------ v - ---------- ..................... ----------------------------- ------------------------------------------------------- -------------- - ----------------- ----- ------ �i e7 eq �iS~ FINAL INSPECTION BY:.--------- = -------------------- Date--------1----d--/- - - 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.