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APPLICATION FOR SANITATION PERMIT Permit No. ___.____-- eihereby (Complete in Duplicate) ` x�Dat�V•.Issue�l / --�-Application 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 Ordin nce No. 549, JOBADDRESS AND CATION------- -- --. ---- - - -- ------ - / - ------ ---------------------------------------•---------- ----------------------- Owner's Nar--- �`'Y-� == - - ----- - - - /� PZh0 __ Addressrj - Contractor's Name____ ---- -�=-1---•---- - - �- - -------- --------- -- ----------- ------------�-------------- ---- ---❑ Mot-- --- -' Phone.. ----��----J•�� Installation will larva: Residence Apartment House E3 Commercial El Trail tourt el bfOther ❑ Number living units: -_`__ Number of bedrooms _ � _ Number of baths __/__ At size Water Supply: Public system Commun'i'ty system ElPrivate E] Depth to Water Tablet. Character of sol to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loan ❑ Clay ❑ AdobeHardpan ❑ ; Previous Application Made: Yes ❑ NoX New Construction: Yes No ❑ PH /VA: Yes ❑ N04` \\4- i TYPE OF INSTILLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) (,eptic ank: Distance from nearest well__________ ___Distance from foundation------------.-------Material________________ ________________._______-. No. of compartments---------- ---------------Size---------------------- ----------Liquid deth--------------------- ----Capacity----------------------- Dispo I ield: Distance from nearest well_________________Distance from foundation____-_-___________.Distance to nearest lot line---------------- L Number of lines------------------------------------ enn th of ea,ach line-----------------------------Width of trench----------------------------------- Type .. Type of filter material_________________________Depth of filter material________________ __Total length___________-____-__________-__-- -__-._ Seepa e Pit: Distance to nearest well �'f___Distance from undation ._ _ ___-Distan�e'to nearest�ot line Number of pits_________________Lining materia Size: Dia eter Depth- � v1 Cesspool: Distance from nearest well-----------------Distance from foundation,----------------- ..Lining material______._._________________.___--____ ❑ Size: Diameter----------- ---------------Depth---!-------!--------------------------------------- Li uid Ca acit ~ ! q Capacity ---------gals. Privy: Distance from nearest well____________________________"! Distance from nearest building______________________ ------------------ ❑ Distance to nearest lot line------------: ,__= ____ ______ 410. Remodeling and/or repairing�(describe): / y w —' " l �^•�.. f __________ ___________________________________________________________________________________________________________________ _ 1 hereby certify that 1 have prepared this application and that the work will bb done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health'District. ` DELTA SCPTIC TANK SERVICE" �I � ;' ` -Owner and/or Contractor) (Signed) ----•- 9 East�th"Str��T-- tlDward 3"9 ------Title!-,�__' i BY�----------•:.,: . St�cktaf� '----- �l+f I (Plot plan, showing size of lot, location o♦�system in relation to well , buildings, etc., can be placed on r vers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______. _c_ __ "R �---------------------------------- --- ----------------------------=--- DATE-------- REVIEWED --- -REVIEWED BY--------------------------------------------- -—----------------------------------'-j------------------------------\DATE------------------- BUILDINGPERMIT ISSUED------------------------- -------- --------- "„' `." t-----------------------------� DATE--------- ----------4--------------------------------------- Alterations and/or recommendations:--------- '- ---------------------------------I r .'., •------------•-------------- -- - - --------------------------'.-------{E �----------------------- - -----•----•--- ------i-�---\-----------------------------------.-------------- -------._.. 1 T At TLS = ------- - ------------------------------- QxQ - - --------------------------•-------- ------ ------- = ---- w see it FINAL INSPECTION BY:. Date -- -------------------------------------. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 sou+k American Street 300 Wez+ Oak Street,, 132 5yeamore Street 814 Nor+h "C" Strae+ Stock4on, California. a{ _ -��yq _Lodi,_California =.. . . ._�y Manteca,-California w _Tracy, California -. < � ^� ES-9-2M Revises 1.57 F,P.CO. >