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VAJ�?I \jCQ' ' 7 ,�- APPLICATION FOR SANITATION PERMIT Permit No. ._..�1__5__.__....____ (Complete in Duplicate) Date Issued ._.�i/S7____ 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, JOB ADDRESS AND LOCATIOL ___ ___"_ �"'� A J cam' Of - /- -t 0 ' n�_..-C? Owner's Name ��-'-` - -� •.�.--r---------------•----------------- -----------------------------------•--- Phone---.v--- . Address-------•'-------------- - --- ----- _QC=- r —..._ 1... Contractor's Name____ z� ----- It l ---------- -r' -1 :,�n Phone. ..__.._.. Installation will serve: Residence U__Y"�Partment House ❑ commercial ❑ Trailer Court F] Motel E] Other E]Number of living units: __- _ Number of bedrooms ____/____ Number of aths --<__. Lot size _______ ___o_''_?�_.__ .__, ------- Water Supply. Publics stem Community system Private [ DDe th to Water Table �Jtt- Y ❑ Y Y ❑ L"C p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availab[e within 200 feet.) 01 Septic .,�1 Septic Tank: Distance from nearest we�ll- ,1 _____Distance from f u d tion__ -.Material_.__ _ __ ________ No. of compartments_ - ---------- Size-_ __ X __.___Liquid depth__sZ--�!-------Capacity --------- ----- - ��pp�� J# 7`* 45 f Disposal F'e3d: Distance from nearest welt-�7. Distance foom foundation.._ -.Distance to nearest lot line___'_�__.___- Number of lines_____!______ ______ ____________Length of each line___` Width of trench_�O_'/ n .t Type of filter matern�--_ �_ Depth of filter material._._--1SI____.__._Total length Seepage if: Distance to nearest weir"------__Distance ro pundstion___ !_ .--_.___.Dista cefto nearest lot line,___�Q___._ Number of pits____-__.__._ Lining mater ial___ ize: Diameter_____ p De th__ ,, � -------- Cesspoo€: 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--------------------------------------------- - -------------------------------------------------•---------------------------•--------- - Remodelingand/or repairing (describe):-------------------------------------------------------------------------••-------------------------•-------------•------------•-------•---------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ --------------------------------------•---------------------------------•-----------------------------------------•------------------------------------ -------------------------------- I hereby certify that I have prepared this application and tha+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rblAsya d I, ions of the San Joaquin Local Health District. (Signed , Septic lank Service z . landfm.Contractor) 7 - ----------- --- - - (9rner ,BY� ------------------------------- (Plot plan, showing size of lot, location of system in relation to wells', buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_—•-- DATE ----------------•------------------------------------ REVIEWEDBY------- -------•------------ ------------------------------------------- 11---•-------------------- DATE ------------ BUILDINGPERMIT ISSUED..-.---•------ ----------------------------------------------------------------------------------- DATE-----:,_.�--•--------------------------------------.--------- f f Altrt' e �os and/or reco ndations____________________________ - mine ------------ __1 ------�`-------------------- ------------ --•_-----„-'- -.a.:� 13.----- - ------------ I --A-�'�"- ' --._ ..A''Fk- •! r: .,`#_r_' =' .°----1-----�ta�- ,-. .-------- --•----------- ------------- ----- _ �'"� ---------------------- _7 ` r „a'R"¢r '4 .c� f i r. fs --_________ -- ---["p---- - ----------------- —�------------ep------�---C-- `` '------------------'---------------------------------------- - FINVAL INSPECTION BY:-- F ---\`\�} ------------------------------------- Date----- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M , Revised 1-57 F.P,CO.