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FOR OFFICE USE: -+ -� ----------- 1 k7 .-.--.-�- - �---- - APPLICATION FOR SANITATION PERMIT Permit No. in Duplicate) t.� -� �j (Complete P ) Date Issued ---_ _?_I __��~ This Permit Ex ires 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 Ordi rice No. 549. JOB ADDRESS AND L CATION-_____- r -- Owner's Name_ . -. ---- -------- - ------- ------------------------- ----------- Phone__j._`f-.---------------------- 7` Address---------------------- - ( -- ---------- ---------------------------------------------- ---- ---•- -- ------------- Contractor's Name-- ------•-- ------ �r _ -------------------•---------------- ----------------- Phone... Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms ��Number of baths _`_ Lot size/x5Z__eX_�_••��1 -_________________ Water Supply: Public system {—tom/Community system ❑ Private ❑ Depth to Water Tablep-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-1gc5S.____..} No ❑ New Construction: Yes ❑ No Ql"'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Distance from nearest well___--------------Distance from foundation-------------------.Mater+al--------------- ----_-__-_-_________. No. of compartments- ------------------- ----Size------------------ -------------Liquid depth---------------- -- -----Capacity----------------------- D os Id: Distance from nearest well_k_4 Kms_Distance from foundation______ ` '� f�__.____-_Distance to nearest lot line___,-_--__ Number of lines--------i----------- ------------Length of each line__ g ------------..Width of french-- .446' --------------- �d Type of filter materia-____ 1 __Depth of filter material__--_/ __"'r Total length-------------_______&0_00Oa pa Pit Distance to nearest well__/-Q7t t Distanc from foundation_ �l _______.Distance to nearest lot line________ -.0 Number of pits-j-----------------Lining materialB4-----------Sze: Diameter-_ �r --- Depth-th__- uu_�� ,,��^^•� /Gail--- -------------- Ces�ool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material__-_---.--__-___-_-._-______.___--_ ❑ Size: Diameter---------------- --------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals' IV Privy: Distance from nearest well------------------------ _____-_____--Distance from nearest building------------------------------------------ ❑f_1 ----------- Distance to nearest lot lire------------- --------------------------- -- - ----- ----------------------------------------------------------- Remodeling and/or repair' ( ) Al-::_ -- --- ---------±------------------------------------------------------------------------------------ ------------ -- - - - - - - ------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State laws, ir/ujllees and regulations of the San Joaquin Local Health'District. (Signed)------.. ---&`---- V,t 4f------------------------------------------- - -- or Contractor) - -- --------- $EF�TIC TANK SER"(:! By:. 97 �Miner,4ye; t lo-e=38n �------- --------------(Titlep--------------------------------- -}- - - - - ----- -------- f (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------'&5 --------- DATE !r - --------- REVIEWED BY ------------ ---------------------- ----------------------------------------- DATE ------------------ ------------------------------------------ BUILDINGPERMIT ISSUED-------------- --------------------------------------- ------•------------------------------ --------:7DATE------------------------- ----------------------------- A terations and/or recommendations--------------------------- ------- ------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----- ---------- -- ------------------------------------------- -- ----- -------------------------------- -------------------------------•------------------------------- -------------------------- FINAL INSPECTION BY:-.-- W;;211_11 ----- - - -------------- -- ��J Date-------- S - s7- S JOA 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.CG- r