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APPLICATION FOR SANITATION PERMIT Permit No. 7_17, .. [Complete in Duplicate Date Issued ._ - - 5 -- Applica*ion 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--__ �+} d . +a Owner's Name .1�'n 1 1�_I- _d_ .. .r'its _ d �i / almfll�. r cl r- /. �4_t7Ft_-_,_... Phone..' ._ O_ - Address ----•------- i t�� (0 �r 1..-�''' �• �o9"ft_�_t? -} --------- ------------- ------•------------------- Contractor's Name------ Zl- 1 , 1.� e1 ----------------------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel [IOther E] "*C-,--- Number of living units: ....1_ Number of bedrooms __Q__ Number of baths __/.. Lot size _,F0. X & / _0 Water Supply: Public system Community system El Private F] Depth to Water Table =oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--fiardpan ❑ Previous Application Made: Yes ❑ No D�--N_ew Construction: Yes [i;-�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Tank: Distance from nearest well. ?'k ...Distance from foundation-J O.. _-.---- Material__._/1_-.__--_--._- No. of compartments._,,_-.. - -- --.--Size-► °.1C.rf'_�?E•T�--Liquid depth...�{ ��. --- Capacity Q 7 Disposal Field: Distance from nearest well---__17�-.-Distance from foundati n___�-41....- r ...Distance to nearest lot Number o; lines_... 1._._ Length of each line___9_Q_ ---------.Width of trench._r�_ Type of filter materialc-�_ �J--Depth of filter material---./f��.-__---Total length____-&Q!-- Seepage Pit: Distance to nearest weft------ ----- -------Distance from foundation-____-___.---------Distance to nearest lot line_._-_-..__-_--_ ❑ Number of pits-------- -- ----------Lining material--- -------- --- ---Size: Diameter--------- ---------- -Depth_ .---- --- ----------- ------- 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 (describe):... _tc..------_=------- i---- , trh j----( r{d�i__5------------ - -- -----------------•----- --------------------------------------691, - . C ` ----- -- ------------------------------------------------T-- -- -------- --------------- -------------------- ------ ------------------- -._------- Oi /- .------ ------------ --------- - ----------------- ------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --------- --- ! herebycertify that Ihave - - - Y 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. DAY $ NIGHT {Signed}_-.- S-eptic.Tank_Service-------------__--____A-we, 1206 So. Eldorado HO 2-704e, Con+rector] -----BY' -------------- - i+le{Plot plan, showing size of lot,Sloca onrofasystem in relations, buildings, etc., an be placed on reverse side). rf' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- - -- ----- - ------ :.----- -- ------. .----------------------------------- DATE REVIEWED BY- ----------------- r'7 ---------•---:------ - --------- -------- --- DATE-- == UlLD1NG PERMIT l55UED_--�---- ---- ------ -- - ------------------------------------ Alterations ----------------- --- ----- - ----- - ---------- DATE ------ A aerations and/or recommendations:.._._._..____ .- - -------- -- -- ---- ---------- ------ -- -------- -------- ---- - ---------------------------------------- --- -- FINAL INSPECTION BY:..... _-..--/� '---:-- - bate - � ------.---- ------ -- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California X5-9-2M 11-6 Al W... 12-54