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✓�� APPLICATION FOR'SANITATION PERMIT Permit No. --- ..�!_5.. (Complete in Duplicate) Date 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 County Ordinance No. 549. j1(pl-t4 41kG(l 04(-. ,360--05 .Zea 24:)3 C- � JOB ADDRESS AND LOCAT! N..._ - - �lcL�•,x� r {� ..-- ------__-__________ - 1.- LU. 'f" n ----- -------- - - Owner's Na e.- ` - �� ice_ ••� -`----•Y-----•- --------- ------ Phone �,.--- / Address -1F - Contractor's Name-------------�- 4. 8.'1_ - 4"---- i --..1 Al2-1----- _P V_.1L�-------- Phone._ - -.. - - s ...------ 1� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑ Other ❑ Number of living units: )3-- Number of bedrooms ---�- Number of baths -------- Lot size ----.---r J-63-0,0 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 ❑ Clay ❑ Adobe ❑ Hardpan ❑ . Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 f t tr'D Septic Tank: Distance from nearest well__-.---- Distance fr m fo ndation_ = Material--- `-�-+_h---'�- r Liquid depth--- $--.----_ P Y ❑ No. of compartments--�-------------------Size- ------? - ---- pp/ Disposa10.Field: Distance from nearest wet#.0311_'�_Distance from foundation___ P-.---..--.Distance to nearest lot line_&_ Number of lines------ -____ _ Length of each line--. '- --- ----------Width of trench-- a2- �f Type of filter material- --►L.-Depth of filter material----1 _'Pf------.-Total length----/f_ --------------------------- Seepage _---___-__--.- P 9 �- ---- __ �'�t-�..--. Distance to nearest lot line--.- Number See a �Pit: Distance to nearest well-�___.._-..-_ Distance om fo�undation----__ Number of pits.--3_______________Lining materia#A'A �--.-.Size: Diameter_- ML ---- Depth-- ------------_ Cesspool: Distance from nearest well-----------------Distance from foundation---.--------------- Lining material---.-__..-----------.___----------- ❑ Size: Diameter---- - -------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. 1"I'li Privy: Distance from nearest well ___------------------------------.--------------Distance from nearest building------------------------------.----------- ❑ Distance to nearest lot 1 e ----------- --- -------- --------------------------------------------------------- -------------------------- ---------- y i � r T� Remodeli and/i repairing [d cribe�:_---------------- r .-- ,---___.- _ _ ------------------ t- . - - -�-� �--- �`` - ------------ I ---------------------------------------------------------------------------------------------- ----•-•--------------------------------------------------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and ru�j �p 1418 �ns of the San Joaquin Local Health District. (Signed)---_ 1 ' SepttiicTTank Service I ....1206 Slifeir do No z-yQ4b--------- - ----- ----------- - ----- ---------•----------------------------(Owner and/or Contractor) `--14--i#ar dan -- -----(Title)--------------------------------------------- --------------- I l y.._....- .-Cali# ------------- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). _�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ --------------•------- --------------------------.- DAT REVIEWED BYDATE----.T? E.._.-._. ------------------ -------------------------------- - � --- ------------------------------------------------------------------------------- DATE-- �------------------------------------------------- BUILDING PERMIT ISSUED----------- -- --------------------------------------------------------------------------------------. DATE.------- ------- Alterations and/or recommendations:___- -------.: _ -._-------------lh--.--.-_--.•------------ -•-•------------ T --- - ��:__ . .. .`� - _ y. ....::..:... - - --------------------- - _----_--.----. .------------------_-------_-_-------- : ------_ _.-... p FINAL. INSPECTION BY:.---------- 15---------------- Date----------------` -- ...... : - ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street j Stockton, California Lodi, California Manteca, California Tracy, California 31I Es-9-21A 345446 ATWOOO 12-54