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Jf APPLICATION FOR SANITATION PERMIT Permit No. it/' (Complete in Duplicate) pate Issued ....__��_�_j:?-- This Permit Expires 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-----3-61---W•----7t-ha------St.------------St-Q_CktSJ.171-------------------- ------------------------------------------------------- Owner's Name-------------------P3St_ox---Eagkab-o----------------------------------------------- --------------------------- ----- -------- Phone--------------•------------•------- Address-----------------------------------------------------•3-65-- W._.._7th.----sS_------•------------------------------••------------------------------------------------•--------•--••------------ Contractor's Name--- !he-- - --- eptic---Tank---------- ----------------------------------------------- Phone-- i Installation will serve: Residence [( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----1- Number of bedrooms ___-a- Number of baths _ ___ Lot size _____ . Water Supply: Public system XX Community system ❑ Private ❑ Depth to Water Table ---35ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2[X Hardpan ❑ mi Previous Application Made: Yes =No ❑ New Construction: Yes ❑ No M FHA/VA: Yes ❑ No ❑ Supplermertary TYPE OF INSTALLATION AND SPECIFICATIONS: . � r Drainage ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y Septic Tank: Distance from nearest well-----------------Distance from foundation---------------------Material__-__-__-----__-______________________________- No. of compartments _ Size Liquid de th-___.--__---_-_-.._______-Capacity EX�tin = r Disposal Field_: Distance from nearest well 'N_p,C].e___Distance from fo'undation_1_._-1i7 P_____.Distance to nearest lot;line-----6_t_....... ExiMting Number of lines------I------- -----------------Length of each line----351-----~-----------Width of trench-----a4---_-------------------.-- & ADD Type of filter material-E_ep_tr__ {kms_Depth of filter material--__._].8..........Total length-----------15-t______________________ \ Seepage Pit: , Distance to nearest well----None-------Distance from foundation______2,C_l.-.__ .Distance to nearest lott.______ X Number of p'sts----1___.----------Lining material---RQ� 31 k_------.Size: Diameter----- . 1--------- Depth---------2-5t---------------- esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._.______._______.________________ [] Size: Diameter------- -----------------------a----- Depth-------------------------------;--------------------Liquid Capacity------------ ---------------gals. Privy: Distance from nearest well.yam_________________:_.__----_._.____._.__Distance from nearest building.-___._______________________._----_._._. ❑ "Distance to nearest lot line------------- --------------------------------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe):-----------------------_ _ --` < - -. ----------------------------------------- --------------------------------SUFPLEMFZT_ARY,.DFRA_ZNA.GE----------------- ----- ----------------------------------------------- -- --------------- 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 and regulations of the San Joaquin Local Health District. (Signed)----T.he---DAY...&__DIGHT---Septic...T_ank--Sery _ e- =----- -=------------------------------------------( Contractor) By:-------------------------------------------------------------------------------------------- --- -- ---- --------(Title)---------------------------------------- -------- --------- (Plot plan, showing size of lot,,location of system in relation f ells, buildingsfc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- � D __ DATE._____._ -__ __'�� REVIEWEDBY----------------------------------��-=- —- -----------------' ------ DATE--------- - -- --- ---------d--------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------`---------------------------------------------- DATE -------------------------------------- Alterafions nd/or recommendations:--------------------------------- -------------------------------- --- - == ------------- --------------- ---•---•-- 1----------------- ------ --------------- - - -------------------------------------------------------------------------------------------- ---- - _--- - --- :--- -- ±= --- - -------------- --------------- - -------- - -- - - -- --- FINAL INSPECTION B ---==-------- - ---------- Date SAN JOAQUIN LOCAL HEALTH DIST CT 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 Revised 8-'59 F.P..Co.