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FOR OFFICE USE: ----------- - Y6 -------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. .._....- ---r ------------------------- (Complete in Duplicate) Date Issued -------------------------_._._ - - This Permit Expires 1 Ysar From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to cons ruct-anb install+fie work herein described. This application is made in compliance with County Ordinance No. 549. Gvl _ - ------- JOB ADDRESS AND ATION 7 ---- -- �] Owner's Name---------------------`{-'--��----- --------- -- - -------------- ------------------- - ----------------- Phot "-- ea '� Address--------------� ---- Contractor's Nal r --- Phone--------------------•-------------- -- --- --- -• � --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote` [I Other ❑ Number of living units: _f --- Number of bedrooms YNumber of baths ./----- Lot size --- ---� " --------------- Water Supply: Public system ommumty system ❑ Private E] Depth to Water Table_ ft. rJ l Sandy Loam El Clay Loam El Clay E] Adobe Hardpan E]Character of soil to a depth of 3 feet: Sand E] Gravel ❑ anY Previous Application Made: (If yes,date--------............) No ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) r T Distance from nearest well---- -----------Distance from foundation___._____________..Material_.-___-__.___..___._._-_.__________.______.___.- 1 No. of compartments Size-------------------- Liquid depth Capacity Q, s Q el ). Distance from neargst welllJ' Distance from foundation_-4 . ^_-_Distance to nearest lot line----- .- v i Number of lines----(----- ----------: - Length of each line�_�---�----- .�.Width of french------ --------------- f.: ., T"ype of filter materia Depth of filter material-____-__I _._Total length__..[-- -: --------- -%4 Number / _.___Distance to nearest lot lines_."- ------ \` Seepa e Pit: Dis ante to nearest well._(y_ _____ _______Distance om undation_____. ____ �l ---Depfh_.-�.., ----------------- ) Number of pits.___/_.__.__...."'".'Lining material_ _._.___._.__ _. ._._Size: Diameter._.��-- .- - Cesspool: Distance from nearest well-------- %_-Distance fro foundstion.__________________Lining material__._____.------- - "teals. ❑ p -Liquid•CapacitY - A Size: Diameter---------------� ------- ----------De th---------------- _ 9 l Privy: Distance from nearest well----------_ #---------------------- -----Distance from nearest building--------------------------------- - ----- ❑ Distance to,nearest lot lire-------- `�.-------- ; :----- I Remodeling and/or repairing (describe):---------------------'___ - --------- ------------------------------------------------------ -------------- ----------------•--------------------------------------------------------- .: - = : --�-, �► 0. : } - ----- - ----------- -- - - ------------------------------------------------------------------------------ 1 hereby certify t}tatAVIes ave prepared this application and that the work will be done in accordance with San Joaquin oun y ordinances, State laws, anand regulations of the San Joaquin Local Health District. r ebary- &�n,-k . - r Contractor) Sined _ ------------��..-------- --- { g �EPTIL--TiANK S'F_n— 2915 E.Miner Aver • HA-fi 3841 -------- -----(Title)------ -------------------------------- -- - -------- (Plot plan, showing size of lot, location of system in relation to ells,46uil4, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY _. .. APPLICATION ACCEPTED BY--- ` �1 DATE = ° fREVIEWED BY-------------------------------- ------ DATE----------------------------------------------------- -------------------- DATE -- --- x BUILDING PERMIT ISSUED- , - - - -------- - Alterations and/or recommendations:. 3 f3 ------�---- = ---------------------- - ---------------------- FINAL INSPECTION BY:.. Date--------.--17 1-..... . -5. . --- =--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P.E o. "