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�1 `� 0 APPLICATION FOR SANITATION PERMIT Permit No. .1J�r'. (Complete in Duplicate) / ly This Permit Expires 1 Year From Date Issued Date Issued _. ----- 1.... _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insjIthork herein described. This application is made in compliance with County Ordin e No 549. JOB ADDRESS AND LOCATI N.... _ ----- -- -.-- Owner's Name ,[tl ------ Phone ----------- ---------------------------------... - ..-.... .. -------------------------- --------------------- Contractor's Name��- �--�[� .. __ i►�' �- - #Ic- lw 4----• Phone 1 � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ote - ,ther.1❑ Number of living units: .__ ..�Nu ber of bedrooms ---f_ Number of baths /..... Lot size. �.X�_.... _._. -- ----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-ft.— Character of soil to a depth of 3 feet: Sand ravel E] Sandy Loam ❑ Clay Loam [j Clay C] Adobe ardpan El Previous Application Made: Yes E] No New Construction: Yes ❑ No A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tics Ta : Distance from nearest well.................Distance from foundation-----------------.-.Material-...............--._....___--.___________---- No. of compartments----------- -------------Size------------------------------- Liquid depth------------------------- Capacity---------------------- osal - Distance from nearest well................_Distance from foundation--------------------Distance to nearest lot line.-.-_...__-..._-. Z---q Number of lines-----------------------------------Length of each-line-----------------------------Width of french.---------------------------------- 0 Type of filter material-------------------------Depth of filter material----------------------.Total length------------------------------------------ P i ._..............___---.____..__...-------Pit: Distance to near e t well_AB-U-------Distance from � n CI�Ifoundation---J0.-..__.Distace to. nearest d -lin------------------- Cesspool: ---- 40 --- � Number of pits-. ----------..-...Lining material-90 Size: Diameter_. .nf_.__._.Depth____ --- ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_.-.....___------....__.._---------- Size: Diameter--------------------------------------De th--------------------- --------- ---••--............Liquid Capacity gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.._....._....-._.-_..._-_-------.-------- ❑ Distance to nearest lot line-- --- ----------------------------------------------------------------------------------------------------------------------------------- - Remodeling and/or repairing (describe)-------------------------------------------------------------------•---•-•--------•--•------------------------------------------,-----•------------------- , ------------•------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------••-•-----------------------------------------------•---------------------------------------------•------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Stale laws, and ru�apc&rpZns„of, the San Joaquin Local jQ j0 ijrict. DAY F- r .- Septic Tank Service ` M ------140-144 (Owner and/or Contractor) (Signed)------ By:..... . ---------------==-----�t�Stl l9dE8�11>------------------------------------------------------------------------{Title)-------------------------------------------------- (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-------•---------------- ----------Q---- E----------f -Z- -- --- - REVIEWED BY--------------------------------------------- ---- -- - V_s ------------------------------------------------------- DATE--------------------------Y- ------------------------ ----- PERMITISSUED-----------------------------1---------------------------------------------------------------------- DATE------------------------------ ------------------------------ Alterationsand/or recommendations:-------------------------------------------------------------------------------------•---------------------------------------------- -•-•------------------------- ---------------------•------------------------------------------- --------------------------------------------------------------•----------------•------------------•------------------------ --------------------------------------------------•---•-•--• - ------------- - ---- --------•----------------------- --------------------•---------------------------------------------------------------- - -- -- ------- --------------------------------------------- - --- -------- --------- ----- ------------------------------------- -- -- ----- -------- ---- --- --- -•------- i- -------------------------------------- ------------------------ FINAL INSPE Date----(..".�� _"� SAN JOAQUIN LOCAL HEALTH DISTRICT h 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Cv.