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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) cf/ Date Issued Applica%n is hereby-made to the San Joaquin Local Health District for a permit to construct and install the wor This application is made in compliance with County Ordinance No. 549. k herein described. = IE JOB ADDRESS AND jLOC A ION �n �' � ^` a ----------------- Owner's Name. A; - ---' ----------- - ------------- ----------- Phonezx Address--.1/27 --i------------ -•- - , Contractor's Name---------- ---- • �' -�2.t�- `T. Phone- '.A.7q Installation will serve: Residence [r Apartment House ❑ Commercial ❑ Trailer Court-❑ Motel ❑ Other ❑ y Number of living units: --.! Number of bedrooms _Number of baths /.-__ Lot size __. -_t�-Q------------------- _ ater Supply: Public system ❑ Community system ❑ Private Z,-1<epth to Water Table - eft. Character of s6il.4o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3-11ardpan ❑ Previous Application Made: Yes ❑ No 2"' New Construction: Yes M,.-<❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if��puubblli�c sewer is available within 200 feet.) ly Septic T k: Distance from nearest well-"°.. --.11--Distance from foundation- - Ll i� No. of compartments--Z rr �, Material - - -�- .Size-s -- -E -- Liquid depth--..3'"_� Ca acit [�-ca Disposal field: Distance from nearest weal_ ----- Distance from foundation.---- _:-_-Distance to nearest lot line._- --:57--- Number of lines---,.1_-. Length of each .line----- _ - - ----- -- ------ -Width of trench- --�-�--`------------- Type of filter material-.- —--_S Depth of filter material_---_ - -- --- a . p /e�-=--- ------Total length- ----h�--�--- �- -------------- F Seepage �t: Distance to near well -. __ --- _ Distan�rom foundation_-_-.- -` ' `� _---.Datance to nearest lot line_----_- Number of pits.-- il...-.--._ .. .;ning material. ------Size: Diameter--- If - - Depth----- •---------- Cesspool: Distance from nearest well-"N------- ------Distance from founclation'k Lining material-_- --_ .- Size: Diameter. - - --,_Depth- _.:=== _ �- Uquid.0 Privy: Distance from nearest wail ----- _--- -------------- - ---------Distance from nearest buildin g Distance to nearest lot fine -� Remodeling and/or repairing (describe):--.------ ----------------------------------------------------------------------------------- -------•---- --------•--------•----------•---------------- = ----------•------------ -----------•--- -------- I hereby certify that! have-prepared this appIicat iornand that the work will be done in accordance with San Joaquin County- ti I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY& NIGHT (Signed)---------- Septic Task-Service 12D6 So.Eldorado ------------- - - --- -- - --=---- ------ r Contractor) By:.------- scfC#on;kali#: - ,. (Plot plan, showing size of lot, location of system in relation to we l , buildings, etc., can be placed o-- reverse side-- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B REVIEWED BY -------- DATf"� .------------------ -------•----- - ---•---- - , -- ----------------------------- ------ - �----------- ---------------------- - ----------- DATE_ ---------------------------- ---- BUILDING PERMITISSUED---- ---- ----� -------------------- DATE.-- Alterations and/or recommendations:--.----.-------------- - t3-`• '----_ ------------------------------ ---------- --- -•----------- - --------- -----------------------------------•------------- ------------- --------------- - -------------------------------------- - ---iz FINAL INSPECTION BY: .� Date--... _-_ _ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak S+reef 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 745446 A7woo❑ iz.sa