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FOR OFFICE USE: _ __________________________-___-.---.----.--_-.-__-_-- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------ - -- - ---- --- (Complete in Duplicate) Date Issued ____ This Permit Expires 1 Year From Date Issued 2lt(- 3rary/ Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and install th,work herein described.;: This applicat1F � on_is made-in compli a with County Ordinance No. 549, s e j ,c c JOB ADDRESS AND OCATIO __ ;. -_ _ ._- .- ----z-W--- - q p � 'An------------jOwner's Name D - - - - - - ' Address--_© P F#, �n Contractor's Nameh�. Si1u ---- •--- Phone6 "'- =`z� Installation will serve: Residence [&/'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ' Number of living units: J----- Number of bedrooms 2---_- Number of baths3----___ Lot size __ -------------------------............ 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 [B/ffl'ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑: Previous Application Made: (If yes,date....................: No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑l. —TYPE-OF-INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ti S is T Distance from nearest well------ ----------Distance from foundation--------------------Material---------------.__._...-------------..._-- No. of compartments---411-60 ---- - Size--------------------------------Liquid depth------------------ -------Capacity-------- ------------- Distance ------ ' J isposal Distance from nearest . Distance from foundation -------- Distance to nearest lot line__ 40___-. aQ ! Number of lines---.I__-_ _-- _-._ _ Length of each line__74'_ Width of trench�.V_'10-__- ____ Type of filter ma ___ p g - �� Depth of filter material_______ _ .__._Tota! length -------------- - `* Seepa e Pit: Distance to nearest well-f*D -------Distance from fou tion -__-_______-Distance to nearest I t line__lO____.. Number of pits.-_ .._____-_-_.___Lining material` Size: Diameter- -X 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--------- ----------------------------------------- -------------------------------------------------------------------------------------- t Remodeling and/or repairing (describe):-------------- ----------------------------- -------- ------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ -----------------------_-- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws rules and regulations of the San Joaquin Local Health District. (Signed) �a �i�ht wContracto .:__SEPTIG{TANK�S�1�VECr �_--- 1 [,0w = ._•-------p �- --•�--�..-r - r) 5 E Miner Ave. Ho.6.384.1 T By;R91---'-Mi _, ---- ----------(Tit e)---------------------------------------------- - ---- --------- (Plot plan, showing size of lot, location of system in relation t ells, building , etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------�r_K_V ---------------------------------------------------------------- DATE--------X-A A6-------------------- i REVIEWEDBY----_-------------------------------------- --------------- ---- - ------------------------------------------------------- DATE-----------------------------------------------------------' BUILDINGPERMIT ISSLIED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------- ------------- Alterations ---------= Alterationsand/or recommendations------------------------- ------------------- ---------------------------------------------------------- ---------------------------------------------------- --------------------------------- ------------------------------------------ -------- ----------- - ----------------•---------------- I ----------------------- ----- --- -------- ----------------------- ----------------------- - - ------------------------------------------------ FINAL INSPECTION B - = -- ---- Date--- - - ---- � /1 -------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California