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Permit No. _.7..:3--�-U----- � APPLICATION FOR SANITATION PERMIT l C, I� (Complete in Duplicate) Date Issued V 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. p �,.-�— ------------- --- --r----------------------------------- --- ----- JOB ADDRESS AND LOCATION__.__��A-.-.--��-------�-- '�--- - --�----� " �-<- -�-?�--- ..._ Phone __�i�,a4_ ------- Owner's Name-----------------""---- - Address •---------------•------------•-----------------------•----------------•----------------------�/ Contractor's Name--------------- �--- '--------------------------------------------------------.... Phone-44-70-1/6---- 4-701/6---- .� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �/ •u-d@N -a------------•--•-•------"- Number of living units: __�___ Number of bedrooms ______-. Number of baths __�__ Lot size __.''`�" " Water Supply: Public system [�Community system ❑ Rrivate ❑ ..Depth to Water Table .'T�ft. i Character of soil to a depth of 3 feet: SandPP r Gravel ❑ Sandy Loam . Clay Loam ❑ Clay El Adobe 2---/Hardpan ❑ Previous Application Made: Yes El No New Construction: Yes ;o ❑ y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic T nk: Distance from nearest weil4l�---Distance from foundation._ _.._.___...Material_.___ ......... --. tf tl d� No. of tom artments..� Size_ _.�_�"."F;��iquid depth__. ` __. __..:�_____._.Capacity___ ________________ f Disposal Field: Distance from nearest well-". �._Distance from foundation___"-._.----Distance,to nearest lot line.... Number of lines--1-------- --------- -----------Length of each --------------Width of trench---,L4+`�!`-------__----. --- Depth of filter material ___._ /.�_�f_ Total length--- "______________________ �_� Type of filter material_ ._ __....�..._..._ i " p 01s Seepage Pit: Distance to nearest wellolip-nD---------Distant fro foundation -Distance to nearest lot line----o5�------ Number of pits---I"""."_-----------Lining material-+ 5---------Size: Diameter_".33_--"--------Depth-c ---------------- Cesspool: Distance from-nearest-well________________Distance#rom founda#io-�n "._._�--bniiig'mater1 l_.�1 ._--_____.__:__"______".____ Size: Diameter----------------------- ----Depth------------------------------ - - -----------------Liquid Capacity--------------------- gals. Priv Distance from"nearest wel4-------------------------------------------------Distance from nearest building----------.-.-------------•--------------- ❑ Distance to nearest lot line------------------------------------ ------------------------------`------------------------------------------------------------------------ Remodeling and/or repairing (describe)---------- -------- ---------._.: ._--------------------•-•------•--------------•--------•-----------------------•-------------••-•---------..------ ------ - ----- --- -- --•------ ------ ------ --- I hereby certify that I have preparegd.this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules AY re NIIGHT of the San Joaquin Local H Ith District. (Signed)- ' Septic Tank Service ----------- ---- oniract 1206-56 I:Idorado IKO�-7046 (Title)--- By:-•-•------ ------------------ In,--Cali.---------------------- - --- --- - ------ - - - - --- - ----------------------- (Plot plan. showing size of lot, location of system in relafio wells, buildings, etc., can be placed on reverse side). FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ - --- -- --- ------- DATE. - ,- .......... ----------------------------- ------- --------------------------------- REVIEWEDBY-------------------------------- ------------ ---- - --- -- -------- ------------------ • ------------------- DATE-- --------:--J-C BUILDING PERMIT ISSUED---------------•---------------- ------- - ------- DATE------------ ------ -- -- ---------- --------------- Alterations and/or recon datios:. --- ----- -------- ----- ------------- --------•----------------- ----------• Zs-�-"-----------•---`- -------•------------------------------------...---------- -•-- - - = ----- -- t -------------------------- --------- ----------•- ------------ ----------- -------- ------------------- ---------------------------------------- -- -•------------------------\ --------------------------- -------------------- ------------------------------------------------------------------- --------------- FINAL INSPECTION BY------------------------------------ - ---- --•-•----- Date-- r -SAN JOAQUIN'LOCAL HEALTH DISTRICT I,k-SouthAmerican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M 145446 ATWUCD 12.54