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pp ruts Vrrik-t uot: �3 ------______________------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------- -- --------------------------- --- (Complete in Duplicate) Date issued -- "- This Permit Ex� ires 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 with County Ordinance No 549. JOB ADDRESS AND LOCATION_ -------.L6.- C. . _ � -------- p f Owners Name =-- 1---i- ` -------------- -- -------- Phone---"i-2-er- '17.j Address----------------------------- . " Contractor's Name -- ------. - ---------------------- Phone.!t` ?_i�` 7 Installation will serve: Residence [a-Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other I- Number of baths _ Number of living units: __ .____ Number of bedrooms ---l/ �____ Lot size ��_y______.�.__1.______________ __________ r Water Supply: Publics stem �Communit system Private Depth to Water Table _ _ ft. i� PP Y� Y Y Y ❑ ❑, P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandyoam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------- --------) No ❑ New Construction: Yes ❑ NoHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:)`= - S�T . dist.nce from nearest well---------_-------Distance from foundation-------- ----------Material----------_...-."-.-_..___--_-.-:.._______. No. of compartments--------- Size---=----------------------------Liquid. depth_ Capacity`..-"� ------------ i ---------•. ief�: Dist Fnce from nearest well dhV�_Distance from foundation_ / ____.:_Dlstance to nearest lot line___�______.... 5� Number of lines --- -----._-_-- ___----Length of each line__-_-- -0_._-------..Width of trench---- _ _____ _________________, Type of filter material_ __ __. _. p „! De th of filter mate iaL"__.___� F°__.Total length-----________ Q-fl________._.W y Seepage Pit: Distance�o nearest welh_ �� - '__.____Distance tom undation"_��_�______.Distance to nearest of line.__�_�_.'�_- � Number Cf pits.--]ti.:- ------x �L Hing material---�----- Size: Diameter__' Z/1-- ---Depth--- - --------------- ----.---- ----' - -0 Distance. from newest ell -----------Distance from f undation___._____-"_-__.__.Lining material----------------------------------- Cesspool: W Size! Diameter--------- ---------- ^--------__--De th---------------.________- Li uid Ca Capacity-. als. ❑ ., p - ; q p Y-.----- -----g ' .� , Privy: .0 Distncfrom nerest well: -----------------------_.____._..------..__-Distance from nearest building--------.._______________-=____...__._. V9' ❑ Distance',to�;Pearst lot;line'----------------=- ---------------------------------------------------------------------- .00 (d�scT�be):----- - ------------- `,---------- ------------- ' ------- `�`_� Remodel------and -- re inn """""""r-r" __-" " " ""r ------ -- --�l6�-� ---------------------------------------- — a---- --- A_ ---- ---- ! --- -------------- ---------------------------------------- hereby certify tl1t'I have ire ared this a-------------------------------------------- "lication and that the vr ' ------------------- ----------------- x jp p� pp pork will be done in accordance with San Joaquin County 0 ' ordinances, State j�laws�nd mules and:regulations of the San Joaquin Local Health Dis Dict. (Signed] �.[1 .-��C -•-/1 •� .. „4._ 14- i ° + Contractor)iwikSEPTiC TA14K SE'h Cil ---------- -- •-- - ----- Title---------------- ------------- ---- - -- ---- -- -----`(Plot plan, showing siz of lot, location of,system in relatio , bui�,etc ca.n,,bexplaced;on reverse side). tom.. I FOR DEPARTMENT USE ONLY 1 APPLICATION ACCENTED B ------- ;-__ -- DATE_- -------------------------------------- REVIEWEDBY------------- ----------- ----- -- ------ F �nF: --------mss:-_-v----------------- --- DATE BUILDING PERMIT ISSUED------------------------------------------------ ------------ - DATE Alterationsand/or recommendations---------- ------ ----------- -------------------------------------------------------------------•-----------------------------------------------=----------- ------------•----------•---•---- --------------------------- •------------------------ ----------------------------------------------------"---------------------------------- ---------•--- --------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: 4L -- Date % ------------------------------------------ SAN -------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California , F.P.CO. f