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-FOR OFFICE USE: e '�-------- P rmit No. -------- -- ----- 1 .w1P.M-------- APPLICATION FOR SANITATION PERMIT 9 -- 0------------- "' J (Complete in Duplicate) Date Issued _�.-_�- _(a ------------pp----- ---------- --- i' �' ' '4This'Permit Expires I Year From Date'Issued Application is hereby made to the San Joaquin Local Health District fora permi# to construct and install the work herein described. This application is made in. `compliance with County Ordinance No. 549. = Q t r Q.HISS-4.1a--•---------------•----------•---••--•---.... JOB ADDRESS AND LOCATION.. -_�:_ SGS---t5....-----20 ------ p Qzct' Phone Owner's Name ln._ty-_-----�. Y i 7:_�,. _S?4Q.�.rS------C_n ' Address Wit .. - r ------------------------`--------------------------------- ------------ v 5� Contractor's Name.. -----------------------i Installation will serve: Residence X ,Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other El j -._. Number 'of baths __,l-. -Lot size ._ Q � ------- ---••- Number of living units: ___ . Number of bedrooms ----" ---�-••--� � - Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel El Sandy Loam E] Clay Loam ❑ Clay [1Adobe Hardpan ❑ Previous Application Mt ade: [if yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes E] No [I. TYPE OF INSTALLATION AND SPECIFICATIONS: i _ l (No septic tan k'or-cesspool permitted,:if ublic sewer-is available within 200 feet.] ' _ /Q.-------.Mater•sal- ------=----------- -------- Septic Tank: Distance from:nearest wnell. -P- -----Distance from foundat'son._... . -----Size___doi� _. zr, _Liquid depfh.w'1� -"� -------Capacity--9!0..tjj. No. of compartments....-r.__...-__ - {-f a tk Distance from nearest weIL. Q_�_..Distan e r m foundation__._Zd------ Distance to nearest lot line._-__a,_._.._. Number of lilies"�_:,3_ "� 9 _ .---Len th of each line,7d.:.. fJ �-Width of trench-------- .' r , �� of#iltPr material___-.-..- -..._ .Total length..-- -'--• -0-------- Type of filter matte Y;y x y _ ' S a e P' : ' Distance to nee est;well_...-_ ~`.' __- - >Distance'from foundation______________;._:_.Distance to nearest lot ine-....._._.- -... Number of pits,' - =Lining material Size:'Diameter----- ------------------Depth------- •--------- i � l. _ esspool: Distance from;nearestwell..._......'.s.._Distance from founc]ation..__..-__.._-_.._..Lining material___--....-.... aj$. ❑ ,f. Size: Diameter---- ------- ---------------F ..Depth---------------------•----------------=-------------Liquid Capacity ----�- -------- -- 9 .1.. - Distance from nearest building.f- : - Privy: Distance from nearest well.-----:..' -- ----- - *•- -. ----------------------------------------- 5 .. - -- . ..----- ❑ stance to nearest lot line------.•'--- D I ----------- d r're airin describe E-�--- - �. ��4Y"_Q1�t_--- �--•---��`----.�'K.t. ..- �- - d.' -•-= Remodeling and/ p 9 ( r) 'F : ' y L --- f ....... ---- _ .�+ _ -u ------ `• - t ------------------------------------------------------- -_ ----------------------------------k-- ----------------- ---------------- --�.•------------._------ I hereby certify that I have prepared this application and that the work will be done in accordance wi an Joaquin County ordinances, State laws rules and regulations of the:San Joaquin Local Health District. .................. ( Contractor) (Signed)------------- _(Ti - ` �SY gP 1C TANK SERVICE ____(Title") ByZ:v ;-:---nE3t �VZS": rrtS'2=3 C? ex (Plot plan, showing size of lot; location of system in relation to wells, i11 Ings, etc can be placed on reverse side). ( iy FOR DEPART ENT USE ONLY j t I _ APPLICATION ACCEPTED BY _ .3 1 DATE------------------•-----...-------------------------------- DATE-------------------------------•-••-----------••---------- REILD NG PERMIT ISSUED------------------------------------- wk - DATE----------------------- -------------------- ----•--------- BU . . --•------------------------------- ---=----- ------------- Al+erations and/or recommendations;__-:----�_---- •-=-- ,-z., ---- ---------------------- ------- ------------ ----------- - ----- - - ----------------- Date... ----- FINAL INSPECTION '�'SAN.JOAQUIN LOCAL HEALTH DISTRICT .-- ,. 300 W Ir.. Oak street 124 Sycamore street 205 West 9th Street 130 South American Street . ., Tracy,CaliforniaStockton,California Lodi,Californla Manteca,California ' ES-9 REVISED 8.59"'Do'7M 6.66 l!