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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �'Z-K:�Z -- ---------------- ----------------------- ----------- (Complete in Duplicate) G Date Issued ----------------------- -------------------------------- This Permit Expires 9 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 with County Ordinance No. 549.9Z---------'= JOB ADDRESS AND LOCATION --��Ja------ Z--------'=-------- /1 Q G Phon ��1J-- Owner's Name--- �- 1� ---- -•l f�------------- ----------- e__ Address ---- 1x- _--••-"----------------------- -------------•-------------------------------•--------,--•--•----- e .Contractor's Named_ `IJ /� �• Phone. _. (Installation will serve: Residence partment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r� t Number of living units: __ ___.. Number of bedrooms Z..._ .Number of baths J---- Lot size .1,7Q---------�r---p---�-------'-- ------ Water Supply:~ Public system ❑ Community system ❑ Private epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelardpan ❑ ; Previous Application Made: (If yes,date..... -------------1 No ❑ New Construction: Yes ❑ Now FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tan or cesspool permitted if public sewer is available within 200 feet.) $ k: Distance from nearest well-----------------Distance from foundation__.-________-_-____.Material____---_____-_--______--__-_-..._____.____._____. No. of compartments------------ --- -----Size--------- -------Liquid depth------------- - ----------Capacity----------------- I Di al Fi b: stance from near st well___ .Q."e Distance from foundation-- Width to nearest lot line____ g Number of lines---- "." ------ ----Length of each line___________ Width of trench."_"_.______rr �f Type of filter material* ------Depth of filter material---- _"______Total length------ Seepage Pit: Distance to nearest well------------ ________Distance from foundation----------- to-nearest lot line.-_---._________ ❑ :j Number of pits---------------------Lining material-----------------------Size: Diameter--.-------------.......Depth_.------------------------------- Cesspool. ' Distance from nearest well-----------------Distance from foundalfion_-________-_._____:Lining material__-________-_-___----.._________-___. ❑ i •. Size: Diameter- Nr ----- - - Depth--------------------------------------------------Liquid Capacity----------------------------gals. Distance from ne h 1 _ ------------- - ------Distance from .nearest building--------------------------------------- Privy: «-f El Distance to nearest lot line_____ _______ _____ 4 rarest well'-:------------- --- Remodeling and/or repairing (descr�i�e)' ---- - - s. 2 _ - ~ -.-"------------:'n ----_ ------------------- •-_____---------- .. . ___h J4+� --l--------x-------o---z----n-i---- ____________________________________ ____________________________________________________________"-_-____-___________-___________.-_-_.-__________-_______-__----____-__________-_____-_-___-_-_--______.---_----_____-_._.-- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aW rules and regulations of the San Joaquin Local Health District. �j� :-;- (Signed)------------------- "y---�`�----�!�t---- ------------------- -- - ------ ----- �r Contractor) ) � SEPTIC TANK SERVICE --------------- --------------- --- ---- - -- (Title) SY= �7� :Pdfr�rftve:: �Q:"6-3g1 (Plot plan, showing size of lot, location of system in relati to wells, build' S. etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------ ------ -- --------------------------------------------------------------- ------ DATE---------- 0V ------ ----------------- REVIEWEDBY------------------------------------------------------ ------------------------ ------------------------------------------- DATE- ----------- ------------------ ---------------------------- BUILDINGPERMIT ISSUED----------------------------------------- ---------- ------------------------------------------------ DATE------------------------------------- ---------------------- Alterationsand/or recommendations-------------------------- ----------------------------•---------------------------------------------------•--•----------•--•---------------------- ------- ----------------------------------------------------------------- --------------------------------------------------------------------- -------------------- -------------------------------------------------------------------------------------------- ----------------------------- --------------------------------------------------------- ------------------- ----- ------------------------------------------------- ---------------------------------------------------------------------------------- •-------------- --------- ------------------- --------- ------------------------------------------------------------ ------"-------------------------------------------------------------- --------------- ----------- -------------- ------------------- - -- - ---------------------------•-- ------- --------------------------------------------------•-------------------------------------------------------------- ----------- FINAL INSPECTION BY:------. -(',�------- Date-- ---------- ��r 6/7-- ------------------------------- --------- SA 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 1 F.P.CO. i