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APPLICATION FOR SANITATION PERMIT Permit No. ...l..'��---0.... t1 (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San oaquin Local Healt District for a permit to construct and install the work herein described. This application is made in compliance with County Ordin nce No. 549. �J e. `d® ' � YY � s-- ® . -----e�►,s",11.._ ® JOB ADDRESS AND LOCATION______________ ¢-- -• - - _3n;?-------•------------- - --------------- Owner's Name..--- �'��------ --------= ---�-•------- f a , __4___..X._;7,04__ Address----- .L:.�.. �1= ----- ----------•-------- ` Phon Contractor's Name--------- Installation will serve: Residence/�partment House ❑ Commercial ❑ Traile�Court ❑ Motel ❑ Other ❑ J ! umber of baths --- Lot size .--- -- --'-- .. ---------- Number of living units: __._____ Number of bedroo s _> • _ - „•• -.• t Water Supply: Public system ❑ Community system Private ❑ tDepth to Water Table a Character of soil to a depth of 3 feet: SGravel ElSandy Loam lay Loam ❑ Clay E] Adobe❑ Hardpan ❑ Previous Application Made: Yes E] No No New Construction: Yes ❑ No �&+' TYPE OF INSTALLATION AND SPECIFICATIONS: &et' No septic tank or cesspool permitted if public sewer is available within 240 feet.) Tqn Distance from nearest well-- -- Distance from foundation--------------------Material------------------.___.-------------------- .__._. " '` No. of compartments--------------- --------Size------------------------•------Liquid depth--------------- Capacity--------- ------------• r� .- osal F Id: f Distance from nearest well---------____---Distance from foundation__________________Distance to nearest lot line_____:_._._.___. `�^ Number of lines------------------ ----------------Length of each line------------------- .Width of french----------------------------------- � Type of filter material-------------------------Depth of filter material-----------------------Total length-------.------------------------•--------- ` ____Distan fro fo tion__ ____ Dista e to nearest lot Ime___ m Seepag i}: Distance to nearest we � � --•- � -- --.Linin material_ ---[:J[-�F ize: Diameter__ _ . De th___ " -----f.- --1 Number of its.__ . _ _ g - p �'�� Cesspool: Distance from nearest well-------------____Distance from foun ation__--________.___- -- Lining material------------------------------------- tj ❑ Size: Diameter------ -------------------------------Depth-------------------•-- --------- -----------------Liquid Capacity- --------------------------gals1 ` -Distance from nearest building ------------- ----- Privy: Distance from nearest well ---------- ------------ ---------- y ----------- --- -•-------- -------•-------- '+ ❑ Distance to nearest lot-lire- --- --i----------- ,_:�,% �. --------------- -- Remodeling and/or repairing {describe):-------------------------------------------------------•------------.---------------=---. ------------------------------------------------------- i -- ------------------------------------------------------------- ------------------------------------- ------------- - --- - ------ --- - ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County h ordinances, siaie laws, and r*Afni of the San Joaquin Local Health District. Septic Tank ServiceContractor) Si ned ' ( 9 )---- -----1-206-so;-fFdt►rrrdo---}{o-s-7#?ab----------- - ----------------------------------- ----- By:__... !qM.Calif.__. (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ACCEPTEDBY DATE_ --------------------------------------------------- APPLICATIONREVIEWEDBY------------------------------ _---------------------------------------------------------=----------- --------. DATE---"..."--------------•---------------------•-•------------ -- DATE-----�► ------------------------- BUILDING PI=RMIT ISSUED----------�------ ---------- ---------------------•----- -------------- --------------- �'--------------------- -- Alterations and/or recommendations:-------------- --------- - -----------------------•--------------'----------- -----------------------I---------------- --------------------------------- ------------------ ----- -------------------------------•-•---------------------------------------_ -- --------------------- ------------------------------ ---•-------•------ ,�_. ------- ------ - ------------------------------- FINAL INSPECTION BY:_.__ �� -------- Date__.7---�._747-4---------------------------- -----�f-•------- `w- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California �y ES-9-2M 145446 A7W09D 12-54 � £