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FOR&IkI USE: ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ..�.` . . `: * ' -----------------------A- ----------------- (Complete in Duplicate) _� f¢ 1 --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ._2..:....... ....... 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 No. 549. JOB ADDRESS AND LOCATION.. __ -----25_____________________ -_w�i3C__a.2O__�_�ustX11-_,R,d....BQ.W.LSN:G..GEEEN..EST. Owner's Name.................................. �....Gen. . ---Cmtr-r--------------------------- Phone TA.--.3allfh..--------- Address---------------------------------•-------.. --EQx...392--KIt-,-1--malteca--------------------------------------------------------------------......------....._.... Contractor's Name...The_-DAY----&.3121...,Septic.---Tank..Serv1a.a..................................... Phone.._W-63843 ....... Installation will serve: Residence [N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....I Number of bedrooms -3,_XNumber of baths.*... Lot size .33.01._.X.3-5:!............................. Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ME Clay Loam ❑ Clay❑ Adobe❑ Hardpan❑ Previous Application Made: (If yes,date____________________) No ID New Construction: Yes [I No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -- " -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sceptic Tank: Distance from nearest well 50t_____DisoWA* 6undation---31--------Material_�-C�.C:.:B��,rI'F:.. ZK No. of compartments__-__-__2-------------- ------Liquid depth.._ L_Capacity.: ..Cxals, Disposal Field: Distance from nearest well------5Q!...Dista ce from foundation......20A Distance to nearest lot line......6 ....ry ZK Number of lines......2------- __.__.__._Le olfeach2l'In e------- __..Width of trench ._ 0 Type of filter material S.e-p_tC___ Depth of filter material_-_-_-,9t!--------Total length.... .../Co 41 Seepage Pit: Distance to nearest well_____________________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............................ Privy: Distance from nearest well-----------------------------------------_-------Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•--------•--------•------------............----------- Remodelingand/or repairing (describe):---------------------------------------------------------------------------------•-------------•---------•------_...:-----......-----------------.------ . ------- ---------------------------------------------------------------------------------------------------------•-----------------------------------------------------------------------.....-------- I hereby certify that I have prepared this application and th the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San J q in Local H th District. (Signed)...TI-DAY---�c..NI ET..----Septic..-_lank.--Se C ------ - ------------------------------------- 7�E Contractor) By:.......................................................................................... --- ------ --(ritIa)------------------ ----------------- ---------- - . (Plot..plen.showing size of lot, location of system in relation t ells, but ings, etc. a be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------�1' p -- �------. DATE------------ . REVIEWEDBY-------------------------------------------------------------------------------- •------------------=---------------------------------------------------- -----------------•--------.. DATE--•--------------------------------•---------------------- BUILDINGPERMIT ISSUED------------------------------------------------- -------------...................................... DATE..................................................----•---- v. Alterationsand/or recommendations------- ---------------------------------------- -------------------------------------------------------------------------------•-•----------•------------...... ------------------------------------------------------------------------------------------------ ------------------------------ --------------------------------------------------------------------------------------------- 1`.(o....-16-�....... ....... ---------T-�-1i--o,--------------y2lo©------ --------------------------------------------------------------- ----------------------------------------------•----------- -------------------------.. ................................................................................................... FINAL INSPECTI Date----------AA ..01 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 EM 6-61 ATLAS