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G.^�^ rvrcvrri�.t Uat: n -- ------ -------- ---------- - jAPPLICATION` FOR SAN_iTATION PERMIT Permit No. _. 7-"T ------ ------------------------------------ ------ (Complete in Duplicate) I ----------------- -------------------------------- This Permit Expires 1 Year From Date issued Date issued __ '" -� Dl `13 — — G� Application is hereby made to the San Joaquin Local Health bistrict for a permit to construct install w k herein described. This application is made in compliance with County Ordinance No. 549. d � � `-f 2 O eV. H.< W, M Ad - � JOB ADDRESS AN LOCATION -- "-�f'"" - ,� ""a Owner's Na __- e___- - -___ Ph - - =--- - -- -- - ------------- -------- Address. one - --------- ----------------------- - - Contractor's Name gP - ----------------------------- Phone.._ F _R Installation will serve: Residence [ 'partmen�t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ j_____ Number of bedrooms _1Number of baths J___ Lot size ------ _-4�41!� -------- Water Supply: Public system ❑ Co mmunity system E] Private _: epth to Water Table /0.04, t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ oba Hardpan C]Previous Application Made: (If yes,date -------------____.-) `No ❑ New Construction: Yes ElNo FHA/VA: Yes E] No E] i TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ :-41"_-Distance from fours ion_,/,0__ Material___:. .____ r No. of compartments nn �� 1 P moi•----- -�-----Size - �-- ---_ squid depth__--1J-------- Capacity Dis Field: Distance from near st well/AC -`_Distance from foundation_ �— > " --_..--Distance to nearest lot _ Number of lines__" __ . t_ - - -__Length of each line_____ "! Width of trench_,r2.4�g-----r"""-_ 4 Type of filter materia _ __-" _ Depth of filter materia-__If-""Total length________________ �� Seepage Pit: Distance to Weare t well. Q___-""-"-pistance from oundation___ Distance to nearest lot line_._-- Number of pits__.-.__._.........Lining material_ 'i Size: Diameter__. �� ------ Cesspool• Distance from nearest well----------____""-Distance from ounda+ion___.___---__.__.___Lining maferia!-------------------------_)-------- ❑ Size: Diameter------- --- - -- ------ ----Dep -------------------------------------- --------------Liquid Capacity-.---------------------i---gals. - Privy: Disfance from we _-_-- Distance from nearest lauildin I .I► g--- --------------------------1--------- ❑ Distance�}ofhearet lo�`lme - - 1*1 Remodeling and/c r0ai4nT.(c7escrib6)- __ t. --------------- Y ---------- �---•----------- -- -- - ------ -- -- ---------- ---------- '� ----------- -----------------•------------------------------------------------------------------- t------- } ------------- 4------------- ------ --------------f----------------------•----------- x I herebyycertify that I have prepared this application and that the work will be done iii accordance with San Joaquin County ordinances;.a5tete laws, �rulbstand regulations of the,San,.Joaquin4Looal Health Disfrict: .r �- /�f 1• (Signed)__;_:!4-----�a`�----�?`-----'!`�� - ----------------- -- ------------------- Contractor SEPTIG TAI�iK SERVICE - ---- - -- ----------------------------------------- ---- - - " " - !- ) ey:.-�95 :iWirter Ave. = -HA_5 384' - ---- - ._- r (Ti#le'}'_ ------ (Plot plan, showing size of lot, location of system in relation t wells, buildin , etc!can be placed on reverse side). ' FOR DEPARTMENT USE ONLY F 1 APPLICATION ACCEPTED BY. -/` ....... ---------------------------- DATE------ - �1 . -- REVIEWED BY ------------------- ---------------- ........... DATE --------------------- ---------------- -------------------- ----------- ---------------- BUILDING PERMIT ISSUED ------------------ ---------------------•--------------------------------- DATE-------------------------------------------------i Alt ions an or recommendations:._---�---- ----�-f�"-------�.:.Z_$_��-----.L-`-- ' -- ---- - -- - -- - ".� <1 - -------------------------• --------- �9--''T+�- �.�..U."'------------ ------------ - - ----- ------------------- -------------- ------------------ t ------------------------------------------------------------------------------- --- - ry FINAL INSPECTION BY:............C_-� "----. - Date....... ' --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 30 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.Co,