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a -'`FOR OFFICE USE: - ------------ --------------------------- Permit No. . .. .. -------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERM (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. 549. JOB ADDRESS AND LOCATION--- ----Euclid__________---_---------------- •------------•------------------------------P-•h•-o--n--e----H-•-°---------.---------- Owners Name --------------------- .-.-.-.- • --------------------------------------- Address --_ Address---------------•------43- 1q,,-- Euclid--------------•- --------------------------------•----------------------------....----------------------------•-- Contractor's Narne______._.� � t-t Sept i�---Tank Sex'Y ie Inc, ----•--- Phone.Ho. 4-9Qp .Q- Installation will serve: Residence L2 Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ a X laQ Number of living units: --- Number of bedrooms __2__. Number of baths Lot size __ ____---------------------------___--------------------- Wafer Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam F1Clay Loam ElClay ❑ Adobe K] Hardpan F] Previous Application Made: (If yes,date--------------------1 No ® New Construction: Yes;U No ❑ PHA/VA: Yes ❑ No [J: 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----------.--------Material_-_----_______--______-.--_______-_________.___. Exiling No. of compartments----------------------- Size---------------•----------------Liquid depth-------- ----------------Capacity-.-------------- ------ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line..______-___-____ Exid3ing Number of lines-----------------------------------Length of each line------------------------------Width of french----------.------------------•------ Type of filter material-------------------------Depth of filter material-----------------------Total length----------------•----------------T-••------ Seepage Pit: Distance to nearest well------ 10_----------Distance from foundation_____.. Distat�ce to nearest lo�line-_.�____.___. 13 Number of pits-----------1_------Lining material----rock-------size: Diameter------33-----------Depth--?3.. Cesspool: Distance from nearest well-----------_-----Distance from foundation--------------------Lining material_._______._-______________- ❑ Size: Diameter------------------------------------Depth_- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El _________________-________-_-_---------.❑ Distance to nearest lot line---- -------------------- -- --------------------------------•------•----------------------------•- -•------------------- add�n see a e__•_it- Ao---exist-1ng..-aystem -------------------------------- Remodeiing and/or repairing (describe}_____________ __ __ _$--___.__ _P..__g_ P _.._.____ ---------------------------------------------------------------------------------•--------------------------------------------------------••-----•-----------•=----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ) t2L__Septic Tank 3erY$CPy---II1G.-----------------------------------------------------------------(Owner and/or Contractor) By:--------P erg'-Y--ac,---W-arthan ----- Title Gen. M r* (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �--�- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- I ------ --- ---------------- - --------------------------------------- DATE---------f0 'f--------------------------- - REVIEWEDBY-------------------------------- -------•-------------------- - DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------- - -------•--------------- DATE----------------------------------------- ----•-------------- Alterations and or,recommendations:--------—-------------------------------- -------------•---------•--------------••-------------------•-----------------••-•--•--------•-•-------------------- ------ -- -- a -ts`4-------------------------- -` -----------------------------------------------------*---------- FINAL INSPECTION BY------- ------------------- -------- Date =' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [B•9 RCv16Co 9.99 R.P.CC,3M 6.60