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APPLICATION FOR SANITATION PERMIT Permit No. ___..__ll_______.. (Complete in Duplicate) Date Issued Applica+ion 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. or� ---� --------------------- JOB ADDRESS AND LO ON------ - ------ --------------------•-----------•----- -- ---------------------- Phone------------------------------------ Owner's -------------------•-------------- Owner s Name---------=----••-- --1------------ ---�� - � �-;� -- Contractor s Name..__._...�.r " L Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑e_ --" umber of baths :. Lot size --------.3-- .-��---- ---�S,--------------- Private of living units: _.�.__ Number of bedrooms ._.� - - I. Water Supply: Public system ❑ Community system ❑ Private epth to Water Table __._.__. ft. Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam F1Clay Loam El Clay E] Adobe E] Hardpan C] 4 Previous Application Made: Yes E} No /`�1ew Construction: Yes�1�❑` •__ ; TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet:) pticFTa Distance from nearest well_________________Distance fro anon____.._ .__.....Material____..._._...___..___._._.._...._.,_.._--.__.. No. of compartments.....- - Liquid depth--------------- ------Capacity------- / Divosal Field: Distance from nearest well-,5. Y .--Distance from founda#ion_..`... _. Distance to nearest tat line..�� Number of lines___________ _______ -_-_- _-- Length of each line__------�� t Width of french_.__..^-1.��----.- --------- �--.� --- p Total length-------.-6-4---------------------- T e or filter mafiersal_-_? � -�✓�-De th of filter.material_, .�- " ---- YP " Seepage Pit: Distance to nearest wet{__________________.__psstance from foundation--- ..._.."_._-".Distance to nearest lot line_.-..__-__..__-_. 1 ❑ Depth------------------- I`, Number of pits=---------------------Lining material------------------------Size: Diameter------------.---"---- - \ r ist ............Distance from foundation._.-.-..."__.. Cesspool: Distance from .___..Lining material-------------------------- - nearest well..... v $iDiameter_ ------------Depth---------- ------------------- --------- -.----Liquid Capacity------------ -----gals• 1. ❑ I' Distance from nearest well-------------------------- ---------------------Distance from nearest building------------------------------------------ Distance,� ❑ t --•- ----------- --------- ------- Distance to nearest lot line---------------------- ----------- --------- ------�.;*----•"-- ...---"- ---------••---=------------•---------------- Remadeling and/or repairing Idescribe ----------------------- - i �__{ --------I---- --------- -- --- -------------------•-•----------•-----------•---------•------------------------------------------------------- ----------- 1•hereby certify that I have prepared thh+sapplication� �d that Local Health beDis done in accordance with San Joaquin County ordinances, State laws, an les and re u 1YEG=i Joaquin Septic Tank Service .- ---- ner ngor Contractor} (Signed)-------- ------ 1206-50:{Eldorado---HO-2•704 - - -- ------ ----- --------------------- Stockton Calif --- By'----'------'-""'"'"-"`•---- ,e+c., can be laced on reverse side}. (Plot plan, showing size of lot, location of system in relation to wells, buildin 3- p -, R- EP,ART , NT USE O �l:Y" f �'� f DATE----- ------- --`----- APPLICATION ACCEPTED BY__________ __ __ _____" --- - -r —, _-_...__. --- ----------- ------------------------ - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------- REVIEWED BY------------------------------------ ------ - --------- ---------- --------- ----�-- DATE--------- ------------------------ --- •--------------------- - ------------------------------------------ Alterations and/or recommend ations:...................................---•----- --------•---------------------- --------------- „ ---------------------------------------------------- ---------------------------------------------------------- ji ---------------------------- FINAL INSPECTION BY:- ------ ---- ---------------------------- Date �: �� l SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 014 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California y. ES-3-21A 145446 nzwovo 12.54