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Permit No. _._._ APPLICATION FOR SANITATION PERMIT __._____•_ (Complete in Duplicate) S -�--�� pate Issued 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 Count Ordinance No. 5p4^9. (yl v' o- tJ--------------•-----------------•----------_- JOB ADDRESS AND LOCATION...�-- --- - -----,-----•-••---•---------------------------- - --------------- - Owner's Name - - -..Q_�...1! 1 � Phone. Address ------- ---•----- _ --------------------------------------------------------- �j Contractor's Name------- •-•- -a-T-:--- -r--------------------------------------------------------- Phone-/-4---A-7-07/ 5 o Commercial Trailer Court Motel Other Installation will serve: Residence Apartment House ❑ ❑ ❑ ❑ ❑ �1 Number of living units:,--/--- Number of bedrooms _�<Number of baths ---/_ Lot size ------ -______ Water Supply: Public system a--c—ommunity system ❑ Private ❑ Depth to Water Table ._�_C)ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z-'H �ardpan [ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No ❑ `� � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v Se Distance from nearest well-- -----Distance from foundation-------------------_Material_________.______________--____-....____-__-. No. of compartments--------- ---------- Siie-------------------------------Liquid deP.th--- -------------------.._Capacity--------------------_ D' osal Field: Distance from nearest well___r._(�_- Distance from foundation--- -Distance to nearest lot line______________ Number of lines-----=- ---------------- --- --- �} Length of each line__- -`.__ Width of trench_OZ_� _ 0_________________ 02-J4 Type of filter materially ------Depth of filter material___.k---------------Total length,,_W?_p__'------------------------ el Seepage�Pit: Distance to:nearest ---__.___Distance rom foundation___1_Q-----------Distance to nearest of line____S__~ Number of its_-_-_... _Linin material___ -- Size: Diameter_ ''i�`�_____-_ Depth-jre �1 P f 9 ------------------------- Cesspool: DistanceUrom nearest well_-----------------Distance from foundation--------------------Lining material__________.._____.______.____ ❑ Size: Dias eters"..'---------------------------------Depfh------ ----------------------------- ------Liquid Capacity---------------------------ga s. Privy: Distance.,fr m nearest well--------____-_.....______.____________________Distance from nearest building-------.__._..________---_-__.__......... ❑ Distance to nearest{lot-line---------r- `-------------- ---------------•----------------------------------- ----------------------------------------------_:------- Remodeling --- -Remodeling and/or repairing (describe):--___------------------- ----------- -----------------------------•-••----••-------------•-------------------------------------------- ------------•----------------------------------•-----------------------------------------------•-•--------------------•-------•------------------------------•------------.--------------------------------------------------- ---------------------------------•-------------------••--------------------•-----------------•-----------------------------------•-------------------------------------- ------------------•-------------------------- ------ I hereby certify that] have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul ,fid r s of the San Joaquin Local Health District. Septic Tank Service - ---------- ----------- �—Contractor} (Signed)-----• --------.T20iriSo��fiitorac€o /fo�w6ells, �-- �---- ---• - - By:.....--- - slad#q[t,Wif,------------------ - -- -- ---(Title)-- ------------------------------------ (Plot plan, showing size of lot, location of system in relatio buildings, et , can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------_------- -------- --- -------------------------------------•-----•--------- DATE.------ -` - ------ - --------------------------------- REVIEWED BY------------------------'---- ----------- ------ - ------ ------- ---------------------------------------------- DATE---------- ....... --------------- BUILDING PERMIT ISSUED_„_-_---------------------- ---- - DATE................. Alterations and/or recommendations: -- �f_._..----- ---••--------- -- ------•-------•-------------------•--------------------------•-------•------------------------•------ r..................... --------------------------------------•--••------------------------_:-----•---------- ---------•-------------------- - -------•--------------------------- ------------------------------ •----- ------- -------- ------------------------- ----------•----------------- -•----------------------- FINAL INSPECTION BY:.-.:---- ---------------_----------- Date � l ..s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street a 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California M Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATW33D 12-54.