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yOR OFFICE USE: 3 ------------ ------------------- ------------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ./.../_l.___._..__.- ---------- -- -------------- ------------------?_-------- (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued 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 OCATION____I llr--_6 - ��- tr .--------------------------------•--------------------•---------•-- i _137.2, Owner's Name---------- @ I'll'!?1'� e' m_d g9-- — Phone__ Address .9' I"J7- ---------••--------------------- ---------------- --- ----------- Contractor's Name { i 1 � 4 I - _v�-----------------------------•---------- Phone-_ ✓(�-"'..7T�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms�t._ Number of baths __/_ Lot size _.1570_11LIX - Water Supply: Public system 114�community system ❑ Private ❑ Depth to Water Table�l7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Ciay Loam ❑ Clay ❑ dobe �ardpan E-]Previous Application Made: [if yes,date_--___..._,_......I No E] New Construction: Yes E] No FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Distance from nearest well_________________Distance from foundation--------------------Material ------------_------------- No. of compartments---------------------- ----Size------------------------------- Liquid depth-------------------------Capacity------------------- --- D' osal ie Distance from near st welLq .Distance from foundati n___1 -- r /- .Distance to nearest lot line___ or rP�, Number of lines_____ ______ ___ _t-.__ Length of each line___ - -.Q_�_ �_s__.Width trench-ra� !� r -------------- of J Type of filter materia Depth of filter material-__-__ �______--Total length___________________�_p-_------_ Sia a Distance to nearest well_A.Q_I�I-0----Distance from foundation---- Distance to nearest lot line______.._-._ Number of pits____----------------Lining material___�'t@_c"(-_-_-__.Size: Diameter__.. ��_ De th__.- r-------_------ I _4-0 Ai ---- F� Cesspool: Distance from nearest welt________________Distance from foundation___- ------------- Lining material------------------- --"-________-"__. ❑ Size: Diameter--------------------- ----------------Death------------ -- ------------------------------------ Liquid Capacity-. -�-------------- --•-gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin Distance to nearest lot line____.-__- T Remodeling and/or repairing (describe):__ _.---------------- ---------------------- ---------------------------------------------------------------------- ----------------------------------------------------- -------------------------- -- ---------- -- --------- ---- --- ----------------------------------------------------- ----------------- -- ----- I Hereby certify +Iia tJ lave prepared this application and that the ork ill be done in accordance wi+hrSan Joaquin County I ordinances, State laws, ar les and regulations of a an Joaqui L cal H alth District. �' [Signed)-------sEp �aTI yyf lhttANK SERVICE ------ _ Contractor) BY= 2915 E.Miner Ave_ H4,_f,3S41-------------------- - Title Pot plan, showing size of lot, location of system in rel ton to wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y_ a--�e.-. REVIEWEDBY -------------------- DATE---r -------------- `-�--- ----------------------------- -----_---------------- ------------------------- --------- ------------ DATEE----------- UILDINGPERMIT ISSUED------------- --------------------------------------- ----------------------------------------------- DATE------------------------------ Alterations and/or recommendations:-------. ---------------- -------------------------------------------------------------------------------------------------- ------------------ --"---------------- ---------------------------- ------------------ ------------------------ --------------------- --------------------------------------------------------------------- --- ---------- -- ------- ----------------------------------- ----------------------------- ----------------- ------------------ ----- --=- -------------------------------------------------------------------------------- - ------ --------------- - ------------------ - -------------------------- FINAL INSPECTION BY:.11 -------- ----------------- --------- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Qak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Montecar California Tracy,California r- y F.P.0 D.