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7�SFFOR OFFICE USE: -'y 7116 /l4�p/ /......_�._ ..~_ct�--� _�_. APPLICATION FOR SANITATION PERMIT Permit No.r 1,2._ ----------- ------ - ------------- -- (Complete in Duplicate) r --i �_._ p P ) Date Issued __7,.-2 ----- - - -�� -{ - _------ This Permit Expires 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 Ordinances No. 549. JOB ADDRESS AND LOCATION-3--- Owner's Name__�l _ _xvs_ erd-0,07jf-- t..m_��1L�--- s9 � '---------------------•- Phane.�f� __ i�r Address---- / ��J Contractor's Name_, [ ..�01 /l-<--__. 7"`R�e- m"-f- - -- �` +-- Tmi � �� --1----•--------•-------•-- Phone_Installation will serve: Residence �artment House Cal ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __[_--- N ber of bedroom __ Number of baths ./-___ Lot size Water Supply: Public system Community system ❑ ,Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay P ❑ ❑ Y ❑ Y ❑ y ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date............------..) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ;vptic IT k:1 Distance from nearest well-----------------Distance from foundation___________________ Material__-. t�✓ ___.__.____.__-.� No. of compartments--------------- ----------Size--------------------- ------:---Liquid depth----------------------._.Capacity----------------------- +�1 /� v Distance from nearest well j4I"?_LR�_Distance from foundatio ._�_ff-___.__.Distance to nearest lot i`e-__�--_._____ Number of Eines______ ______ ______Length of each lire_____ � _._ .__ ___.Width of trench.r?.�.__ _ n 7 (&: Type of filter materia Depth of filter maternal_._____ _ Total length___________________ _ _ � p Seege Pit: Distance to nearest we1li*A0A_ .____Distance rom ounciation___.I_.-._____.i7' to ce to nearest lot Number of pits---II_____..__.____Lining material-_OC4—_._.Size: Diameter___�t��f.___Depth-._._..Z��............ Cesspool: Distance from nearest well_________________Distance from'foundation._._...__..__.__..Lining material-------___________..__._____-______- ❑ Size: Diameter-------- --------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---________________________________...___._.._._Distance from nearest building---------------------------___---________. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- se and/or repairing (describe)--------- --- ---------- ----------- -------------------------------------------------------- ------------------ •-------------------------------------------------------- :___1 ---------------------- . C��/-- --------- ------------------------- ----------------- ------------------------------------------------------------------------ -•---- -- ---------------------------- ----- ---------------------------------------------------------------- - ---------------------------- I hereby certify that I have prepared this application and that the ork will be done in accordance with San Joaquin County ordinances, State laws, and-ffules and regulations of the San Joaquin Local Health District. (Signed)------------------- �JJhhee A'gl----------------------------- - - --- A ---------------------------------- ------SEPTIC TANK SERVICE r 5 38 z --- -----------(Title)------------------- -------------------- -------- -------------- -------- plan, showing size of lot; locaian o system in relation to ells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------•--------- - - ---- ----------------- ----------- ------------------ - - ------------------------- DATE------- REVIEWEDBY------------------- --------------------------------------------------------------------- -------------------------------- DATE-------------------•--•------------------------------------ BUILDINGPERMIT ISSUED----------------------------------- ----------------------------- ---------------------------------- DATE----------------------- ---------------------------------- -- Altertions and/or re - --commendations---------------------- ----------- -----------------•--------------------------------------------•------ •------•-••---------------------------------------- - -��- "--------- � -- ----------- ------ -------- ------------------ -------------------------------------------------------- • ------------------------------------------------------ �j------------ -------1-------- ,0-------------•--- ------------------------------------------------------------------------------------------------ � � ------S�----- ----- - � . ..--------- r G 'r te t! _.�C A---------------------- ---------------------------------------------- FINAL INSPECTION BY:....... . .------ Date.......-V SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.No:slton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California