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FOR OFFICE USE: -------------- --- --- ------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ...._._... L� (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 w- h County Ordinance No. 549. JOB ADDRESS ALOCATION.... +------�� _n----------- --------------- Owner's Name----- -� '---•---- ---------------- --------------------------------------- Phone Address----------------- --------... --••--- ------------•--- Contractor's Name .Phone..__ _-, Installation will serve: Residence [R� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _3Number of baths,--/--- Lot size .-1_d....._?L --o-� Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ay Loam ❑ y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes No E] FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic_tank or cesspool permitted if sewer,is available within,200..feet.}_,, Septtiic, TTa " Distance from nearest well-0___Distance from fours ation____- -- _Material_______ _ _ �7 No. of compartments-_2---— �-��'�- __�iqu�d depth------- Capacity....�____..__ __ + Disposal Fi Id: Distance from nearest well.---..Distance from foundation---LD -_..Distance to nearest�lot/line____ __.__ [ Number of lines___�__ �.._ g a -__._ ___-Len th of each line Q�_."�"_�Q___.Width of trench_...�-�?________________ __ Type of filter materia ___ _ Depth of filter material___,__�Z�------Total length_____..______-______r__�_ _._ I ___Distance from foundation--------------------Distance to nearest lot line----------------- ElPit: Distance to nearest well------- -- ❑ Number of pits---- -----------------Lining material--------------------.-Size: Diameter------------------------Depth-.------------------------------- cesspool: Distance from nearest well-----------------Disfence from foundation-------------------- Lining material------------------------------------- 0 Size: Diameter-----------------------'------------ Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. s Privy: Distance from nearest well-----___-----------------------------------------Distance from nearest building------------------------------- -- ---- F1Distance to nearest lot line--------------------------------------------- ------------------------ ------- -------------------- -------------------------- .... ; Remodeling and/or repairing (describe)---------- ---'---------------------------------------------------------------------------------•---------------------...... ----------•---------------- i = --------------------------- -- ----------------------------------- --------------------------f------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an&Fations of the San Joaquin Local Health District. (Signed)-. �� ------------ --- ------ ----- ---------------------- -- --� r Contractor) SEPTIC 'T".ANK BERVtCE - ---------------------------231&E:-MInerA e:Y H0.-6 ----------------- (Title). � . ------------------ By: (Plot plan—, hawing size of lot, location of system to rely-rion to Ns, buildings, tc., be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---I-- 1-R-C-o.----------------------------------------------------------------- DATE------- REVIEWEDBY-------------------------------------------------------- -- ---------------------- ------------------------------------------- DATE--------------------------------------------------- ----- - BUILDINGPERMIT ISSUED----------------i----------------- ----------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:l------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------- r � - --------' ---------------------------------------- - -'--- -- ------ -------- -- ---- --- .FINAL IVSPECTIODate. ' ' -�--------------- --- ri - i SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' r F.P.Cd. k