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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application 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. JOBADDRESS AND LOCATION--------- ----------------------------------------------------------------------------------------------------•---------- ,, Owner's Name_----------�``a�`' -_res..�_Ca. �_1.1-�_: 7�?�.�.Q---��:C`oV:1.Gh----------------- Address-------------42-E--4'1-•----&th__St,_ f------------------------------------------------------------------------------------------------------- --------------------------------------- Contractor's Name---------Dalt_a---------------------------------------------------------------------------------------------------------- ----------- Phone____-T'-39_55------------- Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: EIL Number of bedrooms aj Number of baths E, Lot size______ --------------------------------- Water Supply: Public system ® Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3: Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------$;------Distance from foundation____g_!-----------Material---__ 12 No. of compartments----------2-------------Capacity---BQQ-----------Size---f-;C4.................Liquid depth----- 40--------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------^----- - Lining material __-_---_-----------'__-_____.______ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well------------_------------------------------------Distance from nearest building______-.______-.___-----____-___-__..___. ❑ Distance to nearest lot line------------------------------------------------ _ Seepage Pit: Distance to nearest well----------- ---------Distance from foundation------8,t_--------Distance to nearest lot line-_____�---------- ® Number of pits-----1-------------Lining material_Z!.19X-------Size: Diameter------33 Depth------_lgt.____________--_-_ i Disposal- Field.: ..Distance from.nearest well------ '________--Distance from foundation-------1Q1____;Disfance to,neuesf16t lin-e,---2"_� 10= �Olid 1],nE Number of lines-------I-------------------------Length of each line._.__�-Q...................Width of trench_sjG_llCl---l.rkle-__ m only Type of filter material---S-0.11d--------Depth of filter material-_-_. ............. Remodeling and/or repairing (describe):--------1-r-sta ,.lim-___one___�_�.,�___�___C_ei�.___crement_5tebr1Ck__=S-G?Jtic---taaaL 1�it-la---IG-' t----Of �_e��d ��re Frith__o�a� ��.�---33-----Q-dVert:>aal-_dral 18----aeon---t-o-t_al -------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------1---------------- I hereby certify that 1 have prepared this application and that 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. (Signed)-----------------D-e-Ita---iept_i0 Tank___ServlCD.----- -----------------------------------------------------(Owner and/or Contractor) BY: P '7 yho W/, (Title) p�_rae --�' '. -------------------- (Plot plans, showing size of lot, location of sisfiem in relation to wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- .--------------------------------------------------------------------- DATE------ f �.+ ------------------- REVIEWEDBY------------------------------------------------------------------------ ---------------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ----------------------------------- DATE - Alterations and/or recommendations-------------------------------------I-------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ------- ----- - ---------------------------------------------------------------------------------------- - 1 - ----- ----------------- ----------------- PERMIT Na�_ _r'._ ISSUED_____'_ ---___ __-J -__-_____(Date) FINAL INSPECTION---B--Y---:-------------- - Date--------------------- -- ---- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1539