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APPLICATION FOR SANITATION PERMIT Permit No. .-.�-p__�-. __�' i� (Complete in Duplicate) j7T-7/' 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, house on north z2xklgec 2 houses JOB ADDRESS AND LOCATION------ rs_s---from 313__ .0......Eairmanir--- ---------------------moved --in.---------------- '' - ------------ - Phone---HO---�i_$_5�-� Owner's Name------ -�-��-e-�------ -_P._5��';�1__�eQX1��c-�---- -�C_a--------- ---- ------------------------------ �. ------- � Address--------- 12-2----F�--m---MaU ch--ae---------------•---------------•---------------------------------------------------------------------------------------------------------------- Contractor's Name-------? - ' N GI 'o - iC--Tank-- _5_exvlae----------------------------------------- Phone------HO---2-7-046------ Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1_. Number of bedrooms ---Z.- Number of baths _1_--- Lot size e____________________________ Water Supply: Public system RX- Community system ❑ Private ❑ Depth to Water Table 3-Qt ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan Previous Application Made: Yes ❑ No [Z New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ House move TYPE OF INSTALLATION AND SPECIFICATIONS: in. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well__N1�►�.e_---Distance from foundation__�._0_4_________.Material-------Cr�i___-Bx'1Ck__________________- No. of compartments _Capacity �r Ir l p 'Size__5_6_"!x3_6! depth------�-8tt ---------- ----- QO_:_�`r�le Disposal Field: Distance from nearest well_-N-one..._Di stance om foundation-1-01------_ Distance to nearest lot line---- :'_--_____ Number of lines________L------------------------Length of each line_______9Qt---------------Width of trench-------2Y"___._._._---_-___-- Type of filter material_Se_jar___Fk@_Depth of filter material------188 1---------Total length------------ Q=__________-__________ Seepage Pit: Distance to nearest well____NQxl@-------Distance from foundation--- Q!----------Dista sce to nearest lot lin;____ !________ Number of pits.-A--------------Lining material--R_o-ck---------Size: Diameter-------33.........Depth--------2 ---------------- 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_____.______-___________-._______-_____. ❑ Distance to nearest lot line----------------------------------------------------------- ---------- ---------------------------------------------------------------------- Remodeling and/or repairing Idescribe)--------------------------------------------------------------------------..-------------------------------------------------------------------------------- ---------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------------------------------- G . ---------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------------•----------------- (7 ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- ---- - -- 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 SVoe Local Health District. (Signed----DAY--&--N---GHT.--Senti_c__ank---S--e-r�r {�,l Contractor) By:--------------------------------------------------------------------------------- -- ----FS.- FOR --------------(Title)------------------------------------------------ ------ (Plot plan, showing size of lot, location of system in relati buildi etc., can be placed on reverse side). E ARTMENT USE ONLY APPLICATION ACCEPTED $Y------_---------- ------------ — DATE------ ---------_---- �_ •- REVIEWED BY------------- ------------------- = r ` DATE _ ---- ---------------- ---- -------------------------------- r1 BUILDING PERMIT ISSUED-------------- DATE____----_-_---___-_-- - - - - --- - ----------- ------------------------- Alterations and/or recommendations:--- ------------- ---------- --------------------------------------- ------------- -------------------------•----- ---------------------------------------------------- --------------------------------------------- ------------------------ ------ --------------------------------------------------------•----------------------------------------------------------------------------------- `` �.� FINAL INSPECTION BY:--- 9_9x? - ---------------------------- Date........ --- �- `J -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-21x1 Revises 1-57 F.P,CO.