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FOR OFFICE USE: , `,� APPLICATION FOR SANITATION PERMIT Permit No. ,h (Complete in Duplicate) Date Issued -=l --1�� 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 Ordina , e No.Y54 . JOB ADDRESS AND CATION-----�-�. ". �f °_ f ........................./) Owner's Namee'r'�- ------ '��-arm• J----------------------------------------- ---------- -- Phone_ SF�4�° �J� Address-------------------------- -- --- -.[1-1-7... ------ --- ' � � Contractor's Nam __ ---- .-` -� `.... Phone Installation will serve: Residence partment House ❑ ornmercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: I----- Number of bedrooms- Number of baths __/-__ Lot size __./ j ••-•- ---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -tt. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------l No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: AF (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Na5. Material No. of compartments- -Size- - - - Liquid depth-------------- ---------Ca pacify----------------------- Di ------------------ -Di l s Distance from nearei+ well-1`�Q _--Distance from foundation_sl_-.--._.Distance to nearest lot line_ � ____ Number of lines______ ___ Length of each line----ZC)If-------------Width of --�_._ Type of filter material --Dep#h of filter material____..- .Total length____________________ _(�.------- Seepage Pit: Distance to nears t well:lam Distance from foundation_e ______.Distance to nearest lot line-_. Number of pits___ __Lining material_ Si,,: Diameter_._ Depth��Ci -'_____.- Cesspool: Distance from nearest well------------------Distance from oundation---------_----------Lining material------------------------------------- El Size: Diameter---- --- ------------- -------Depth-------------------- ---------._Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well----------------.-.---------------------------- Distance from nearest building---------------------------------- ------ ❑ Distance to nearest lot line---------------- ------- - -- ------------------ -- ---------------------------------------------- Remodeling and/or repairing (describe):._ ---L- ------------------------------------------------- -------------------------------------- ----- ----------------•------------------------------------------------------------------------------------------------- ----------------------------- --------------- 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,,:ad rules and regulations of the San Joaquin Local Health District. / ----------------- Contractor) I (Signed)--- a� - i ii} Areliationwells, ------------------------------ -- SEPTIC TANK SERVICE By's-.91EF_Minee,-Av.........FtC� e- � 7 ---- {Title) --- -- (Plot plan, showing size of lot, locationofsystem in buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- --- ----------- ---------------- ---------------------------------------- DATE--- Q G lam'--------------------------- REVIEWEDBY--------------------- ---------- DATE------------------------- --------------------------------- BUILDINGPERMIT ISSUED-------- ----- ------------------------------------------------------------------- - ---------------- DATE.---------------------------------- ------------------------ Alt t' s n I/or re � - - ommendations: ------ -- -------------- ---------------- ----------------- ------------------------------------------------------------------ ------------------ a ----------� ' -------------- ---------------------------------------- ---------------- --------------------------------------- -----------T-------------------- ----------- ----------------- ------------------- - -------------------------------------- ------------------------- ----------------------- ---------------------------------- ------- ------ FINAL INSPECTION BY: - (� Date / .-.C. ' - 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.C 0.