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+ APPLICATION FOR SANITATION PERMIT Permit No. .... sl.-___ (Complete in Dup4icafe) 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, JOBADDRESS AND LOCATION......../ --5_3�5-- ----------------------------------------------------- ------------------------------- ll! Owners Name-------!_�_GK--- - Phona �C7j� Address------------------ �--------- jr ` •Q '�' Contractor's Name-------------- _�jr ---------------//�C�� h �]��= - Phone �7� Il. Installation will serve:.- Residence Apartment House ❑ Commercial ❑. Trailer Court'[-] Motel ❑ Other ❑ Number of living units: Z--:Number of bedrooms _g__ Numbe;r--of baths 'Lot size ._____ "_ _.__� ____. . Water Supply:" Public system al--tommuniity system ❑-"Private-0,. Depth to Water Table -__-------ft. 5.Character of soil to a depth of 3 feet:! Sand Gravel ❑ Sandy �oam ❑ Clay am ❑ Clay ❑ Adobe Hardpan-❑ F Previous Application Made: Yes ❑ No,�New,Consfruction Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF'INSTALL'ATION-AND SPECIFICATIONS:,-- ' �Q (No septic tank or`cesspool permitted if public sewer is available within 2200 ef.),w S ptic T 'Distance-ifrom nearest wek{ _.-------- Distanceifrom„foundation--------------------Material______________________________________________ No. of compartments---------------------------Size---.,.g -----------_--_�___�Li -`�� Liquid depth-- _ -----:-----------Capacity----------------------- D Disfance.,from-nearest well------------------'.Distance-from foundation-------------_.......Distance to nearest lot line_________._______ Number of�lines---- -------------- -ltength of ea kh dine----------,------_-•-- -Width of french-------------------_------------•-- Type of filter'material--------------- (,__Depth of filter material __________.__Tota:l length___.____._---------- .____ Seepage Pit- Distance toinearest wellfWsS C/-Distance f undation___�=________.Distance to nearest lot line,_c � Number of pits__ _____ _< _-Lining material__ I ______.Size: Diameter_,,%.75_,,5x__----------Depth_4PZ.Ny--_________ _________ Aq Cesspool: Distance from. nearestwell:_.____ _______.__Distance f oundation___._____.__-__-..Lining material_____________________________________. r.�,. .. _ - pth------- - --$--- --=-=--_-=-.�----- :.,Liquid Capacity----------;-•------- gals. N Priv _ Distance`from nearest well__-____ De Size: Diameter_________________.___ 1 ante from nearest buildin Y Distance to nearest lot line.' - - = -----------------=------------ -`- :--- n --_---------------- Re odelin and or repairing describe .___�`” " g P g ' 1 F "► --------•--•--- t } _ 11 r Ycertify. P pa Y. P - -----------------------------------1-----•----------------------------------:---------------- I-hereb )vim II have prepred this a' lication and That We work will be done in accordance with San Joaquin County ordinances, State la n r s .r, ioniiof the San Joa 'uinilLocal Health District. SEPTIC TANK `SERVICE F F (Signed)---- StoCRt01'1-%-Cif'ff------------'- i '�sw�fe*-Cantractor) - - --------------------------------- --------------------- . e 11 t - Title --------------t 1BY----------------------HOwa-r'd--2-7046----- - ------- ( ) (Plot ;plan, showing size of lot, locefiori of system in relation to wells, buildings, etc., can be placed on reverse side). 3 ik t l FOR DEPARTMENT-USE ONLY APPLICATIONACCEPTED BY-- - ----------------+.-----.�-w----------------'--------------------------------------- DATE---------------------------------------------------- REVIEWED BY = - - DATE ------------------------------------- z BUILDINGPERMIT ISSUED------•------- ------- ------ ---- -=-------------------------------------- DATE--- ----------------- = Alferafi 'rfs and/or recoFnmendations ' �r ----------------- - ----- ---- --- -- ------ rit - -ti!-,a+6 ---- ------ _-trs—WIAX-1� � �; _ +<••1`�-��--F �_- '-- ��_��° ----------------- ----------•------------------------' --------------------'!'------ ---------------------------------------------------------------------------------------------------------------------------•--- ----•• .---------•---------------------------------------=---------------------------- ----------------------------------------------------------------- FINAL INSPECTION BY:� ..; �: ``�' '` ( Date- U SAN JOAQUIN LOCAL HEALTH DISTRICT Y 130 South American Street 300 West Oak Street f 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California If ES-9--2M . Revises 1.57 F.P.CD. ,