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_ APPLICATION FOR SANITATION PERMIT Permit,No. .46-7.3-_.-. (Complete in Duplicate) Date Issued Applica-%n 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. JOB ADDRESS AND LOCATION---------0-- � - -----------------------•-••-------------------------------- Owner's Name------- ,5 -- -%- l' � ------- !fc , ---------------------- Phone--------------------------------- Address----------------------- J ✓ ,-_` - ..........................--------------------- ....... -` e ` PhoneContractor's Name-----..�STx---r-- ` Installation will serve: Residence Apartment House ❑ ommercial F] Trailer Court E] Motel E] Other ❑ Number of living units: __.Y mber of bedrooms __ Number of baths .-YLot size __ __-__�____f__ __ ______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _30ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe ardpan F Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No ❑ v245 hj[C(.G.— TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is T Distance from nearest well-----------------Distance from foundation___ l- --------------------Material No. of compartments----- --- --- ----------Size-------------------------------Liquid depth--------------------------Capacity----------------------- osal a Distance from nearest well---------------:_Distance from foundation-------------_......Distance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material----------_--------------Depth of filter material----------------------- length----_-_.____-_-___-______________________- .n � geepa Distance to nearest well--_ s'a. r__Distance datian____� ____-Dis aFe to nearest lot line- _�___ 7 ��-�'L Number of pits------�----------._Lining material-- .Size: Diameter ____________Deptn___—� _________________ 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----------------- - ------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing Idescribe)------- ---------- ---------------------------------------------•---------------------------------------------------------------------------------------- ------------------------------------------------------•---------------------------•......... ------------------------------ --------------------------------------------•-••-----------•------------------------------•-------------------------------------------------...._....------•----------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule, �Qp1 jeLgyl�irigQs of the San Joaquin Local HeaIf District, 133 ii ff��lllltt�ylC"f111 (Signed}... Septic Tank Service or Contractor) ----?Z06-So:��oxacio---NO-2=704i5 -- ------ sy:. 0Siackt�nr_�alif (Title) --------------------- (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............. ----- ------- -------------- ----- �------------------------ DATE--------- .--------- --------------------------------- REVIEWED BY--------------------------------- --- - -------- DATE------ ------7 BUILDING PERMIT ISSUED.----- ---- - DATE-------------- Alterationsand/or recommendations:-------------------- ---------------------------------------------------------------•---------------- --_........ ------------------ --------------•---------------- ---- .. - ---• ------ ------.----------------------------------------------------- ------ -------------•-•- - - - ;-------------------------------------------------------- --- ------- ---- ---------- ------------------------------------------------ - --------------------------------- FINAL INSPECTION BY:. •-------------------- - ------------ Date..-✓. y y x_44------------------------------------- SAN ----- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E" 9 I45446 ATWnnD