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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. r�...8 ---_________________ (Complete in Duplicate) // This Permit Expires 1 Year From Date Issued Date Issued ,� - _-la� -- 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 Ordi ante N . 549. �--�—'�--- JOB ADDRESS AND LOCATIO �! o I�1� Q --- 'a-1_--:_:- �D I..--- Owner's Name------• -.t i � .. - Phoned " 7"2'� _ y Address------------------ -t2?.&------------- ----- ------ --- ................................. Contractor's Nam ----- Installation --=!J_1.Q� Fl� I_!t_q�_ - .!st/ 4° • Phone.T6.`_ 8 � Installation will serve: Residence [Go—�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j-__- Number of bedroom-3 Number of baths -1--__ Lot size ---/3__� 4---2-•3-7----=_____________ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 49 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clayloam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date----------------.---) No ❑ New Construction: Yes ❑ No �HA/VA-. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptiCk Distance from nearest well_____________ Distance from foundation--------------------Material------------------------------------------------- No. of compartments-------- Size---------------------------- J9 q p• Capacity Liquid cle th--------------------------Ca acit -------------------- Dis osl c1 Distance from nearest well0__---_Distance from foundation.._[- -- ._-Distance to neares lo't`I� / �.. Number of lines____l�___ ---_ _ _._Length of each line----A`J__r�_- Width of trench___---,_______ ,� Type of filter materi p g /f- De th of filter material___.- --__ Total len th___________________ See a e Pit: Distance to nearest wellvoo- - --__Distance from foundation-,IJ _.__.Distance to nearest lot li �e-_-_�®_____ Number of pits-_I-_-___- --___-Lining material__-- 8 _-_-Size: DiameterZ13---______________Depth-. �____---:__-______- Cess ool: Distance from nearest well_____-________Distance frooundation---__-------------Lining material___-______------___________________- \ P p, ❑ Size: Diameter- --- --------------- -- -Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------- ---------------------------------Distance from nearest building.---------------------------------______- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------- -----------------------------------•-------------------- -------------------------------•----- ----------------------------------- ------------------------------------------------------------ ------- ------------- j ------------------------------ -------------------------------------------------------------------------------------------------------------------------------------- ------------------- --------•----------------- ----------- I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, mules and regulations of the San Joaquin Local Health District. �a� -------------------- ----- ntractor (Signed)----•--SE}�'i-1�-TANK--SERVICE-------------------------------- --- ------ ---- --A --- I B 2915 E.MinerAve., , H®.6-3541 --- - W-- ---- (Title) - - ------------- - -------------- y: ---------------------------------- -- (Plot plan, showing size of lot, location of system in relation to el s, 'Idings, c., n be placed on reverse side). / , FOR DEPARTMENT USE ONL / APPLICATION ACCEPTED BY_-._-lC- ._ . _--___- ----------------------- DATE_______ -------- REVIEWEDBY----- ------------------------------------ -------------------------------------------------------------------------- DATE-------------- ---------------- ------- .------- BUILDINGPERMIT ISSUED----------------------- -------------------------------------------------------._ ------ DATE----------------------------- ------------------------- ti Alterations and/or recommendations:_-__--j_._�__�_-- __E'_-��-.-____.,__._._� �__.��'`..1�!t'�-•�-.�--r��._._--_ Iy �"'`��-------------- - �L d-_ ------------------------------------------------------------------------------------------- --------------- ---- ---------------------------------------------------------------------------------------•----•------------ --------------------------- ---------- -----•---------------------------------- ------------------------------------------------------------ ------------------- ---------------------------------------- ------------- -------------------------------•------- ---------------------_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL ---------------------------FINAL INSPECTION BY:..-----� ---- Date--------- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.