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GS�7 FOR OFFICE USE: _ _ APPLICATION FOR SANITATION PERMIL, - Permit No. ........... ~� ---------- -------- -----------------------' (Complete in Duplicate) .. _ � Date Issued W --------_a_---.- 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" nfjir Ordinance N 549. ,v I t � - s JOB ADDRESS AND LOCATION .[- �( ------------- 1 �f.----------------------------------------- Phone. I Owner's Name----- � ]-------- � ".00- ',S'.- - - .: > Address---------•------------��96�e-----�^� '` _ ..... AA1-----------------------------------------•-•-•----------------•-- ----- Contractor's Name_._!__1;�� --- - ------------------ Phone---------------------------l 1 ------------•----------------------- --------------•- { Installation will serve: Residence partment House ❑ ommercial ❑ Trailer ler Court ❑ Motel ❑ Other ❑ I . Number of living units: �- Nu r of bedrooms __ ___._ Number of baths_ Lot size ��1�.��---_� ---- ` Water Supply: Public system Corrimunity system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam.❑ Clay Loam E] Clay E] Adobe Elardp._n Previous Application Made: (If yes,date__/_F/p./41(.)�No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tank or cesspool permitted if pullic Sewer is available within 200 feet.) It q we�, Distance from nearest well----------------Distance from foundation Y!y.� _._.__.--Material-______-________--_---_.____.______._'___..-_-- [ � W Na. of compartments------'------ -------'----Size==-'•---- ---'-'------ --•---Li a;d dem-- -----------------------CapacitY------'-------'•----�� . .. Distance from nearest well� �Distancefromfoundation_ ____ ___� l __.___._.Distance to nearest lot line____ _____ ___ Number of lines____I__ _ _ __________ -Length of each"line - - d�.Width of trench._-��i!._ ;! T Type of filter mater; ._- - -Length of filterl,mater' __`--�rTotal length---------------: --- f S i#: Distance to nearest well_ . @.W /11P.---.Di ante to nearest lot sne-----_47r- Number from nation____._. �J Number of pits....I----------------Lining material- ____ -Sue: Diameter___. rf-----Dept h_. '. ial Cessool: zea Diameter_nearest well:-:--- -•--.---_De Distance from foundation-'-------- --'-----Liinurid Capacity----------------- -------------._"�--------- El P q P Y gals. Privy: Distance from nearest well___ ______________________ .._Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line-' ---------- ---------------- ------ -------------------------------------------'---- ---------- ------------------- Remodeling and/or repairing (describe}-____ .- "'�' ----; — - ---- ----------- ------------------------------------------------------------------------------------------------f--------------------- - -- ---- ---- --------------- •---------- ------ 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 f Joaquin L cal Health District. (Signed)-------------- '}at------------------------------------ - - ----- - ---- -- - ---- -------------!------- -------------------- v!! r Contractor B ,SEP'TiC TAMS SERVICE;-- -- -------------(Title)-- --- ------------------ ----------- ------------ -- By- E:'IVITrIer A---.-------- -- �3 I (Plot plan, showing size o lot,llocaflok bf system in rel on to wells, build' gs, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY " = - ---- DATE------ ~�_s3 -:- "` ------------------- REVIEWEDBY--------------------------------------------- ----- ----------------- ------------------------------------------------------. DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------- -------------------------------------------------- DATE--------------------------------------------------=---------- Alterations and/or recommendations:-------------------------- -- -----------------------•---- ------ -----------------------------------------------------------------'---------- i ------------------------- ------'-•-------------------------------------------------- ------------------------------------------------- -------------•---------------------------------------------------------- ;---------- ----- --------------------------' ' ' ------------------------------- - ------------------- -------------------------' --------- ------------ ------------------------------------ -------------- "'-------------- ,fi t l . ��- � --_----------- Date"'--- -- -- - ------------ - FINAL INSPECTION BY:.._____ _-.-- .� -"---------- I OAQUIN LOCAL HEALTH DISTRICT I 160! E.Hasellon AF�!r—L.- Stockton, W T Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. d i