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- FOROFFICE USE: - ----- ------- APPLICATION FOR SANITATION PERMIT Permit No. % .; --------------------------------------------------- (Complete in Duplicate) D .ate Issued 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. 2—P( 2—L(0"02^ JOB ADDRESS ND �OCAT ty le- _ /"_ '/✓!`� -- .. IIC DC7_ Ar.�---------_-l�% l�f? ,J�` -- - Owner's Nam �pl�F'1- 1''E -4 .-- ,Qu !•o _�� Phone Addres��G._t�-o�tEs.._��174�/�- --.1......_1-��1e�r��r /4°�-.-.--��__ C�.f21��`�.�JfIP_.. Contractor's Nam e./ 1.. �._ _f _#'. Lcr �'L--- -',�_�- r(i' -------------------- ----- Phoned Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of Baths Lot size ___r_ _____________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Cl y E] Adobe❑ Hardpan ❑ ' Previous Application Made: (If yes,date._-------- ----------] No E] New Construction:- es la ❑__-FHA/VA: Yes_❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {J . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) °p Septic Tank: Distance from nearest well_l�__-_Distance fro fou11 f i-------------------- ation---4C.-.._ enal Sizer� � �_@ .Liquid dept _Callo. of compartments _p.a..c.i ..t.y........ pQ Disposal Field: Distance from nearest wel2t0____Distance from foundatio �- .� rx? ��_.._Distance to nearest lot line_ Number of line_^--- ---- ----- - --Length of each IineO�C'2_r-___E ---Width of trench�V k-4._ Type of filter mater Depth of filter material- -----.--..Total length,��'Ur -----------/ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_______-_ ❑ Number of pits_-------------------Lining material----------------------.Size: Diameter-----------------------Depth-..------.----------------- Cesspool: Distance from nearest well-----------------Distance from foundstion_-_-___.------------Lining material------------------------------- Capacity .. ❑ Size: Diameter-�----=---------------------------..Depth------ -----------: - -----Li quid Ca ----- -------- - -------- p Y---------------�--�--�----- •`_ - . . ._ Privy: Distance from nearest well------------------------------------------------- from nearest building----------._._-_-_._____-_-_______------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------- ------ Remodeling and/or repairing {describe): ci� ,,^7�j --------------------------------------------------------------------- 1u�-� C=1-c' Ggrll, -------�jwc---------------------- -----------------------•------------------------------- ----------------------------------------------------------------.----- f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Iaws,j% rules and regulations of the San Joaquin Local Health District. (Signed)---- ----------------------------------------I ---- ----- - "------y-=----- -------� --'- � Cnntracto -- SEP'T'1C TANK SERVICE By:2915-E._Miner_Ame.. '-�iU._u 341------------------------------------ ---- (Titley---------------------------- .. ---------.(Plot plan, showing size of lot, location of system in relation tells, buildings, a ., can be placed on reverse side). ,� r FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY 1 - ... -------------- ------------------------------------------- DATE..-----a--- /�._.-_66-h------------._. ► REVIEWEDBY----- - ----------- -------- -------- ------------------------------- ---------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED------------- ------------------------- ----------------------------------------- - ------ DATE-------------------- -- --------------------------------- Alterations - -- - -Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ------------------------------•-----------------------•-------- -- -------- ---- -- - - ------ -------------------------------•------ ----•-••--------------------------------------- -...-.-.---------.-. - ---------------------- ----------------------- ----- - - --- --------------- - -- - r -- - ------------------------------------- --------------------- --------------------...------------------------------ -------------------------------------------------- -- --------------- --- -- - - ----- - ---------------------"0---------------------------------------------------------------------------------------------- FINAL INS' TION BY Date 4� T 9--` _ r - -------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT �1 1601 E,Noielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.