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gyp• -� GOR OFFICE USE: G_1 � Permit APPLICATION FORSANITATION PERMIT ------------- 4. ---- - -------------- ----------- - ---------------- -- -------------- ------ (Complete-in Duplicate) Date Issued - - ------------- ------ -------------------------------- This Permit Expires 1 Year From Date Issued 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. S49. JOB ADDRESSrLOCATIQ�-- --Ye�aS--1---`-- Q+- � d7N`�-, --� -------,r2. ~ - - - -- ---------pOwner's Name--- - ----- --- -- -------- ------------- ------ ------ -------- . -------------------- Phone_ -a-�- , Address----------- ---------- --- -----.f.. ---- -- -------•• ------ -------------------------------- (9 / Contractor's Narrt;-1Z L- --- '�-1 -.e.-- a..� �U'e r------------- Phone. _ Commercial railer Court Motel Other ❑ Installation will serve: Residence�partment House ❑ Co ❑ T ❑ ❑ Number of living units: _./___ Number of bedrooms __J,'_*�Number'of baths---/-- Lot size _ _ _ _ ________ __ ____ _______.______.__---__-__..__.._ Water Supply: Public system ❑ Community system ❑• {Private 9--5_e_pth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel'[:] '"Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date................... ) No ❑ New Construction: Yes ❑ No*—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public)ewer is available within 200 feet.) Septic Tank: Distance from nearest well ____._------Dista�njce from fou d f on___��__.__.__.Mate�� - 9 No. of compartments j-------- -- ----Size�1 —9 ---Liquid depth___._- ____-_. Capacity SS�b- _ Dispo al Field: Distance from near st.well-_ �-------Distance from foundation__�_Q-___----- .Distance to nearest lot line__Z__ Number of lines _-______-__----- Length of each linea@'------.�-0_"__.Width of trench._.__2_a__!.___- Type of filter materia z _Depth of filter material.._1._J'ff-_.._._Total length_____________f '.4,04-- Seepage Pit: Distance to nearestwell-'.......... . . . distance from foundation_______-.._.____.Distance to nearest lot line__.__.____.____.. --- }� ...:, I ❑ Number�of pits.-- -----------..._.__Lining m 1 Size: Diameter-,-------.--------- --Dept h-_-------------------------___--_ Cesspool: Distance ;orrm nearesf,weil ____-" •_Distance from foundation___________________Lining material_-_._--_.________._._-----_----_____. ❑ Size: Diameter- -7'..........Depth_ - x-- ---------------------- --- - Liquid Capacity- ..gals. Privy- Distance from nearest well.-_--� ------------.�" '�- ------Distance from nearest building_______________________________ ❑ Distance to nearest lot line ..---------5-- - A Remodeling and/or repairing (describe):_- = - ----_•------------ ---------- '-------- ------------------------------------------------------ ------------•--------------------------------- - Y -------- --- ----------------------------------------------_.• __,--;;;------------------------ --------------------- ---------------------•----------- ---------- -------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsld rules and regulations of the San Joaquin Local Health District. (Signed)-- !rt, //� -------..------- ........................ ------ - -- -------- ----------- -------------.{e ontractor) 9i�PT1G TANK SERVIGE E. ---(Title)__-_. ByZg3.5 _Miner--Are,-- - -ht4:-6-ss�1�-----�------------ ---- ---- --------------- --- ----- -- ----........---- ---- - (Plot plan, showing size of lot, location of system in relation to wells, but Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY F - ---------- APPLICATION DATE /0-7 - REVIEWEDBY------------------ ------------:-------`..... ....... --- -------- -------------------------------------------------- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------- -- -------------------------------------- -------------- ------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:----- - --------- --------------------------------------- -------------------------------------- -------------- _------------------_ FINAL INSPECTION BY:. ..__._.. ---------- Date------. `rj - -----f�f------ ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1laselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press