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FOR OFFICE USE: -------------------------------------------- -------- PPLICATION FOR SANITATION PERMIT Permit No. ----------------------- --- --------------------------- (Complete in Duplicate) .___ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to co struct and insta5 the gr h 'n descn This application is made in compliance with County Ordinance No. 549. ` 46- JOB ADDRESSop ND LOCATION___�`t ..--_ _ f_. �_—Q .. 77n._. Owner's Name--- ---. _. __- _-----_k Phone ' --- --------------------------------------------------- --- ,. Addressl l t ---------- p� Contractor's Nam -- -------1)aq_%t. M s t -�-` ------ Phone-4gz�.7 Installation will serve: Residenceartment louse Commercial Trailer Court Motel Other ❑ Number of living units: ----- Number of bedrooms--_ Number of bath--_ Lot size _ --------------------------- Water Supply: Public systerrf ❑ Community system ❑ Private W-"D"epth t ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ GravelSa y Loam Clay Loam ❑ Clay E] Adobe ❑ Hardpan E]Previous Application Made: (If yes,date�,f,-rirrs�1*Noeew Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicpwer is available within 200 feet.) S i :1 Distance from nearest well__- Distance from foundation--------------------Material-------------.----_--.-------.-- _----- No. of compartments-.-------- - - . ---Size--_--------------------- ------Liquid depth--------------------------Capacity---------------------- Vsatd: Distance from nearest well__��____Distance from foundatioyl-__1..Qr....../Distance to nearest lot lineNumber of lines------- ----- --------------------Length of each Iine�G '�__ �0 Width of trench----_- -.f-- ly-------Total length--------- 4th , � Type of filter eria_teUc<--_______Depth of filter material___, _ _______ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- R Number of pits------- --------------Lining material--------------.--------Size: Diameter_----------------.---Depth-__.-_.--.-----_---_---.--------_ Cesspool: Distance from nearest-well-----------------Distance from found ation---------- ---------Lining material_______.-----.__---_------__--___. ❑ Size: Diameter------- --------------------------Depth-------------------------------------`----:----------=Ligdid_.Capacity----------------------------gals. Privy: Distance from nearest well--____________________________-- --------------Distance from nearest building----------------------------------._- .... ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):._-----------.------------ --------------- •---------------------- ------------------------------------------- ---- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- --- I hereby certify t I have prepared this application and that the work will be done in accordance with San Joaquin County �4 ordinances, State laws rules and regulations of the San Joaquin Local Health District. lay & 4�I� 4 (Signed).-SEPTIC--TANK--S`�i��/1C-E---------------------- ---- -- - ( a contractor) B .2915 E.Miner Ave.. . HO.6-3841 (Title) - - - (Plot plan, showing size of lot, location of system in relat n to wells, b�uj___ings , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.1, 'Z _-.. ----------//S� _frliQ-- --------------- DATE...... —G --------------------- REVIEWEDBY ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:--------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------�-------�--- -------/------------------------- ----------------------------------------------------------------------------------------------------------------- Ili FINAL INSPECTION BY:.------/1---- - - -----d/� Date-------1/-- ------ -�--------------------------------- SAN JOAQUIN LOCAL H ALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.