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/ APPLICATION FOR SANITATION PERMIT Permit No. .-. _ _____ . (Complete in Duplicate) Date Issued .__-_ __.a _/5% Applica4,ion is hereby made to the San Joaquin Local HPin th District for a permit to construct and install the work herein described. This application is made in compliance with County Orrice No. 549. JOB ADDRESS AND L ON_,____ 1021 Owner's Na �4 ='l ' a.--- Address ` Phone Address. - 3 �'_.- .,. •... --------- - ----------------------------140 -------------------- ----------------- --------Name ...1 '�"` '�^�� `-------------- PhoneV__ _�l _ - ` Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r /r Number of living units: j---- Number of bedrooms --3- Number of baths __� �j of size __--_ ___ -"r.._ ___�__ ral<___ _________ Water Supply: Public system �l�ommuni#y system ❑ Private ❑ Depth to Water Tableofvft. 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 TYPE OF INSTALLATION AND SPECIFICATIONS: _jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Sc.Tan ,, Distance from nearest well _-_________Distance from foundation--------------------Material------------------------------------------------- .w No. of compartments--------------------------Size------------------------•-------Liquid depth--------------- - -------Capacity----------------------- s 3581 Field: Distance from nearest weal_________________Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines- ------------------------- Length of each line---------------.--------------Width of trench----------------------------------- Type of filter material-----____ _____________._-Depth of filter material_______//_..______Total length------------__________________?____ Seepage Pit: Distance to near st weI1..A"- .___Distanc �rom Foundation___C_9__ _-.. is#ante to nearest lot line--.4y________ Number of ;fs..�_______....___Linin material_________. _.__.Size: Diameter"�4 --Depth....-_-_ iel P 9 - Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_______._...__-_...____.____________ ❑ Size: Diameter--------------------------------------Depth.... ----------------------- - - - ---------------Liquid Capacity- .-------------------------gals. 4` . 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 that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules��rlVttf of the San Joa in Local Health District. F`�fu Septic Tank Service (Signed)-.. , ------ - -- ---- -- d/-end/ Contractor -•___-----'330�i-So:�tito"rado_""T,O"2=?O�F�s------- ----- -- - -------- ----- } By:------------ SJiockta ,-Calif.------------------------------ - ------- le}---- -_ - - - - - - -- --- ---------------------------------- (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., JlFble placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ---------------------------------------------- ----- REVIEWEDBY -- - :- - - -------------------------------------------------------------------------------- DATE___W :------------------------------------------------- BUILDINGPERMIT ISSUED------------ / `-- ------------------------- -------------------------------- - DATE----------- ------------------------------------------------- Alterations and/or recommendations:----------.-------_--------------------------------------------------------------------------------------- — ------------ -------------- ------------------------------------------------------------------•--------------_-••---•----•---•-----------------••--------••-•------------••-•--------------•---------•----•----.-.... ------------------------------------------------------------------------------- ---------------------------------••----------------------------- -----•------------------------------•---------------------------------------- f FINAL INSPECTION BY:. ----------------------- Date j`. E `Jj SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWDDD 12-54