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�\,,Y -(�yy / ICATION FOR SANITATION PER' T Permit No. ....P.��!b... V (Complete in Duplicate) ffl Date Issued __..._(_P..f.S.�_. Applice4ion 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 Nyr 549. JOB ADDRESS AND LOCATION. .. �.1 f2 ©_.....` �: �-Z' "' -� .......... Owner's Name -1t9. ----_------- ---- -------- _------------------ Address.................. -------------Address -... -------------------------------------------------- ---------•------------------ ------Q------`=��"'----------------....-----------•---...._------•---------------- ------------•- ---•-------------------_---• Contractor's Name.. y '� ,T'� - t :7---f �i ...........---..............-............... Phona7.�! �i./r!-------i Installation will serve: Residence [R-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: I--- Number of bedrooms _ember of baths _- *sPkot size ........... Water Supply: Public system M c..ommunity system ❑ Private ❑ Depth to Water Table ss? ft. Character of soil to a depth of 3 feet: Sand/❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [R-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 feet.) S Tan : _ Distance from nearest well..................Distance from foundation....................Material.__._..... .......__.___......-._........_._.... No. of compartments--------------------------Size.........-----------------._..Liquid d -- epth-- ----------- - - --------Capacity--------- - D�sposal Fij9ld:!!! Distance from nearest well.----------------Distance from foundation.........._...._._..Distance to nearest lot line................. (t �/ Number of lines..................................Length of each line-----------------.............Width of french................................... / Type of filter material-------------------------Depth of filter material-----------------------Total length........................ ........... Seepage Pit: Distance to nearest well__(`��_.__Distancgyfro�foundation....Z�.�.....Distance to nearest lot lin�_..� Number of its__._....________Linin material....�..........._S_....Size: Diame+er_. .---......Depth.... .......... 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-----------------------_-------..__._._. Q ❑ Distance to nearest lot line--------------------------------------------------....................---.._.....___-. Remodelingand/or repairing (describe):------------------------------------...............-............----..........:..................................— __..-__....-------------- --------------------------...---_ 1 herebyy certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. r DAY 8 NIGHT /, bui., (Signed).....- Septic-Lanlr-Service - - -- afar Confractorj . .......By:..... So. Eldorado H2OF ?x7(Plot plan, showing size of lof, loce�lon 6f sysIli in relefion to wlings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---- DATE... !\ --- .......-........- -------------- - -REVIEWED BY.----------.. ------ - DATE - - - BUILDING PERMIT ISSUED.-.------- -------------------------------------------------------- DATE.-- --------- --- -- ..................................---------- ---------•-----------..... Alterations and/or recommendations :: :: --------------- W+ _- - - -- ------ ---- :: r- -_ - ----- ---..................................- : - --------------------------------------------------------------------------------.--------"_.___.---._...._....._'----'-_"--__-- .......--_... ----------------- FINAL INSPECTION BY:......_v' .`�-- Date._ /... -�� --- .... -- ---- - ........ - - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Sireet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es—e