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APPLICATION FOR SANITATION PERMIT Permit No. . ...... ._` 7 (Complete in Duplicate) 77 a_' T Date Issued Applica-lion is hereby;made to the San Joaquin Local Health District for a permit +0 construct and install the work herein described. This application .is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-•--- 21 1� BS 7h' 'SSG eqS I;oCkori - Owner's Name------- :._... > � IaSD • .. Phone.Ha 2-2' 01 �. ._ �.. Address a.i1i + Contractor's Name_.--=-DAY .------_-- HQ 2 JOi16 --------------------• ------------------------ -•--------------• Phone.-------- ---- ---- - Installation will server ResidenceZ",Apartment House ❑ Commercial ❑ Trailer' Court ❑ Motel ❑ -Other ❑ Number of living units: _I--- Number of bedrooms --3-.- Number of baths ------!Lot size _65-1...... Water Supply:• Public system [$- Community system ❑ Private ❑ Depth to Water Table _ Q,ft: piuS' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M' Hardpan ❑ Previous Application Made: .Yes No New Construction: Yes ❑ No ❑ .. ❑ �- �u��le��e�i.�axy drainage TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------- ----Distance from foundation-------------- Material---_---- El7.Sting No. of compartments--------------------------Size------••----=-----------•------.Liquid depth; ---------- Capacity--- Disposal Field: Distance from nearest well------------- Distance from foundation---------------_---.Distance to nearest lot line---------........ ❑ Number of lines----------------- ------Length of each line_-----------------------------Width of trench----------•----.-------- ----------- E Type of filter material-------------------------Depth of filter material-----------------------Total 'length----.------_--------•-----_-:------ `` Seepage Pit:. Distance to nearest well-.'_Tone--_---Distance from foundation----10-T.......Distance +o nearest lot + line---- Number of Pits---1__-------__----Lining materiaLD.i.c -------Size:'Diameter_----- N6----------Depth------ 5s---__---� s - - Cesspool: Distance from nearest well-----------------Distance from foundation.__----------_----_ Lining material--:__.----------_ -------------------- --------------- -.---_-.- _- --- [� Size: Diameter------------------ ------------------Depth- --- -=----*Liquid Capacity---------------------------.gals. - ------------------ Privy: Distance from nearest well"___________ ___1:-_--------.----------------- -_-Distance:fro_m'rsearest building-': ❑ Distance to nearest lot line -----------•------------------ ---------------•----- ----------------------- ------------------ Remodeling and/or repairing (describe):--------- ---_------_ r -------------------r-•----} ----•------ --------- -------------- --`-------•-- i g ----- ---•--------------------------- ---•---------------•---------•----------- --------------------------- ak I hereby certify.fhat I have prepared fhis•application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. DAY& NIGHT (SignSi ed �` 5e trc Tank Service � ( 9 . [ 8G So ElcTorado` 0 2-�Q_ 0 ( r n Contractor) By� St acktQn,.><:alif_------------- 'o' - -=---- - - (Title) Par tnel ----------------------- ---------------- (Plot plan, showing size of lot,,location of system in relation t ells, buihings, ., can'be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE---4- REVIEWED --- �- - --------- -------- ------------------•----------- DATE-- - ---- UILDINi D 8Y_------ IS ----- ------------------- -------------------------------------------------------------- DATE - - BUILDING PERMIT ISSUED----__._.-- Aaerations and/or recommendations:--.---- ----------- -------------•- ---------•---------------------------••----------------------•-----•------•-------•-----•--------- ---------•---------------=--------------------- i/' : ''� --- -- ------ ---------- - --------- T F� r .. lEr� d=e FINAL INSPECTION BY------------ ------------------------------------. Date = = = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Streef Stockton. California Lodi, California Manfeca, California Tracy, California E5�9—•ZM 145446 arw000 72-s4