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\NV APPLICATION FOR SANITATION PERMIT Permif No. (Complete in Duplicate) IAS A Date Issued ------f-----I--- Applica4ion 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, QCATION--_-T- _-Q-Z- ---... . ....P_&.o -------------------------------------------------------------- Owner's Name -- s---n_V\------------------ ------------------------- ---------- Phone---•--------------------•---------- Address---------- Contractor's Name-----=�Rq --------------------------------------------- Phone-----------------------_-------- Installation will serve: Residence 9?"`Apartment House [] Commercial Ej Trailer Court [] Motel L] Other 1-1 Number of living units: _� Number of bedrooms ___''Y-Number. of aths ----1'*�Lot size -----7--- Wafer Supply: Public'system E] Community system [] Private DZ Depth to Wafer Tableft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam [I Clay ❑ Adobe 0-_Hardpan 0 Previous Application Made: Yes E] No ;��New Construction: Yes E] No ❑ 6 or kx� jtZtjt�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank.or cesspoolpermitted if public sewer is available within 200 feet.) S is Tan Distance from nearest well_._.____-_______Distance from foundation--------------------Materiai No. of compartments----------- - ------------Size--------------------------------Liquid depth------------- - -------Capacity----------------------- osal Distance from nearest well________________-------------Distance from foundation------------------_Distance to nearest lot line________.________ Number ine----------------- Number of lines-----------------------------------Length- of each line--------------------------- Width of trench----------------------------------- Type rench-------- ------------------------- ------------------------ Distance to nearest well--- Distance f I o f ndatio Type ofVfer material------------------------Depth of filter material____.___.___ Total length_.__-___________._-- Seepa 9 Pit M u n--- D-tan to nearest lot line__Z__40 D Nlumber of pits----4,./ Diamef ------------Lining material Depth----- -- -- ----------------- Distance from nearest well________________Distance from foundation___________.._.___ Lining material_______.______---_.__________.______ Cesspool: El Size: Diameter---------------------- ---------------Depth----------------------------------------- ---------Liquid Capacity-.-.------------------------gals. Privy: Disfance from nearest well--- ---------------------------------------------Distance from nearest building__________-____-------__ -------- El Distance to nearest lot line- -----------------:------------------------- - Remodeling and/or repairing (describe):--------------------- ------------------------------------ -------------- ------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------t-------- ----------------------- -----------------------------------------------------------------------------------------I------------------------------------------------------11..___11---------------I—--------------------------------------------- ------------------------- ----------------------------------------I-------------------------------------------------------------------------------------------------------------------1*-----------------------I------I--------- 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, andAnUUNT gia"fions of the San Joaquin Local Health District. I I (Signed)- ---------------------Stockton,-0o Septic Tank Service 9206 So.EldoracfCo 8 =3fGoo Contractor) By ffif--------- -------- -- - ---------------------------------------- ---- -------—- - --------- ---- -----(Title)-----P 1, ------------ size of lot, location of system in relation wells, buildings(Plot plan, sh6wing yo I ings�?tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- -- -------- ------- I---------------------------------------- DATE--------- - ye REVIEWED BY ------------------------------------- DATE--- -;i BUILDING PERMIT ISSUED------------------ ---------------------------------------------------- DATE----------------- -y----------------------- Alterafiops-wW/or 5pcommendSfio%,*__ ------*- - --------- 7 ---------------- )r ------------- ---------------------------------------------------------------------------------------- ------ - --------- ----yr------ _C9 ----------------------- ------------------------------------------------ -------------_----------- ----------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------- ----------------------- -------------------------------- -------------------------- - - ---------------- ----------- -------------------------------------- ----------------------- ----------------------------------------------- ----------- ---------- ------------------------------------------------------------------------------------------------- ------- ----------------------------------- --------------------------------------------------------------------------- FINAL INSPECTION BY:-----9.!Z.S-------------------------:--------------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreof 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100