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FOR OFFICE USE: �/� __ _ APPLICATION FOR tANI�ATION PERMIT Permit No. c ' ------- (Complete in Duplicate) Date Issued ._ _-- �- �-- ------------ 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 with County Ordinance N9. 549. 7 JOB ADDRESS LPCATI --- ------------------_--------- ----- ------.................. Owner's Name----- -----------\--- - Pho4 ' Address --------------- ---_�.. - --- ----------- --. ---- --------------- ------------------------- -- Contractor's Name----- ----�-------- f-----•------- Phone � b � Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1-._-_ IN ber of bedrooms;__ Number of baths _/.... Lot size � �_.� ._.: -_--.-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoX--FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S c Ta Distance from nearest well_________________Distance from foundation--------------------Material_-__-_-___._--._-.--_-.-,._-__-____-_-____---.--. No. of compartments----------------------.--Size-------------------------------Liquid depth---------------- -----Capacity-----------------•---- Di sal F° Distance from nearest well- QIP_Distance from foundation. O_ ___.Distance to nearest lot line____... Number of lines___1____. ._ _ __.__.-__ -._Length of each line-_-___ r Width of trenc 9 Q �+C �n 1� Type of filter material Depth of filter eriaL__-- ------Total length-------------- __ ................> \ `` �� See ge Pit: Distance to Weare twell-!`1��_-.__Distance om oundation__e1`�'_.__.___.Distance�o nearest lot line.__.-... Number of pits-_> _.__..._._____Lining material..__ Size: Diameter__--��_- - -__Depth-___z©_ Cesspool: Distance from nearest well_________________Distance fro oundation--_--.-_.--.-___� 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)-------;�Lff --------------- ----------------- •--•--•-- ------- -- ---- --- - ------ - - --- --- - - --- --- :- -- ---- ...- �---------------------------------- ------------------------------------------ ------------------------------------ -------------------------------------------------------------------------------------- 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 d��/nrrules and regulations of the San Joaquin Local Health District. (Signed) Z �' .. 41 ------------- ----------------------------------- Contractor SEPTIC TANK 70-T-54 ^F�, V c'f' 13y2915-€Mjner-Awn------- 0-T-5� - ---- - -----Angs. - -------•-(Title)----------..--------- --------------- -- -- --- -------- (Plot plan, showing size of lot, location of system in relation 'wells, buildc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---- --------------------------------------------------------------------- DATE----- ----------------------------- REVIEWEDBY------- ------------------------------------. ------------------------------------------------------------------------------ DATE--------------------------------------------- -------- BUILDINGPERMIT ISSUED--------- ----------------------------------------------------------------------------------------- DATE-------------•--------------------------------------------- Alt rations and/or recommendations:-------._ - -_-_ --.-_ _. ...... - -- ----------------- - --------- --- ------------------------ ------ ---------------------- - - , y----------- --------------- -- - -- - -- ----------------- ----------- - ------ ----------- --- ------------------------------------ ----------------------------------- --------------------------------------------- ------------------------------ FINAL INSPECTION BY:- ------------------------------------- Date_------ - � -------------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.a.co.