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11-1 APPLICATION FOR SANITATION PERMIT Permit No.._.$_ (Complete in Duplicate) Date Issued Applic&ion 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. JOS ADDRESS AND LOCATION ------.2.3 ----- ---- ^--- 6 -------------------------- Owner's Name_ - -----------------------------•-----------. Phone---------------- �= Address.---------- - ---- -- ----------- --------``---------------------------------------------------------------- ..__.-...---•--•-•---------..._...._...._......... •--•-----•--...._..-- •...... Contractor's Name ---Tay.-.. . -------•-- 4--- --- ----------------------------------------------------- Phone *,444- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ mber of bedrooms ------ - 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 ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 �(No septic tank or cesspool permitted if public sewer is available within 200 feet.) p ' Distance from nearest well___ ______________ Distance from foundation ------------------- Material ------------------------------------------------- No. of compartments-------------------------Size-------------------------------Liquid depth -------------------------- Capacity- -•-------------------- Disposal F' d: Distance from nearest well-%` :W��_._ Distance from foundation__ 41. ._.__.Distance to nearest lot line ---- 11_.________ Number of lines----/ ---------------------------- Length of each line__----- ------------- .Width of trench ---------------------- ------------ Type of filter material_________________________ Depth of filter material -------------- --.._.__.Total length ------- .-__......... .---_________________- e Pit: Distance to nearest well_. r '___Distance om f undat:an__.._ __ p lQ._______.Distance to nearest lot line _____..____ Ilk1 &V Number of pits ------- /------------- Lining material___ 7•� .__.Size: Diameter__-_�l_-.__-- Depth ------ c2„i� 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 lire -------------------------------------------------------------------------------------------------------------- ------------------------------- Remodeling and/or repairing (describe): ------ ----------------------- ' ----------------_-------- ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --•---------------------------- ---------------------------------------------------------------------------------------•-•--•--•-----------•--•---•--•----•- -------------------------------------------------------- ---------------------------------------- -- --------------------------------------------------•------------------------------------------------- •-------------------------------------------------------------------------------------------------•------------- 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 rules and regulations of the San Joaquin Local Health District. DAY & NIGHT (Signed)..---- �•------------- Septiic_7nnk-Service-.----------- ------- ------ __-- - • -- _(ewif¢T"��Sr Contractor) 1206 So. Eldorado HO 2-7046 By:..... -- -------------------- Sforlrtoe---Ccm----------------------------------- -= (Title].__X1 ��s�--•--- -------------------------------- (Plot plan, showing size of lot, location of system in relation to wel ,buildings, etcan ..be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---•---------- -- ••-----•------------- DATE------------ -� - �fb�� REVIEWED BY - A ' ------'"`_'----------- ----- DATE-------------------- �-•-----•-------•----•-------•------- BUILDING PERMIT ISSUED ------------------- --------------------------------------------------- DATE--------- -•------------------ -- --------------------------- Alterations and/or recommendations-------------------------------------------------••---•--•-------------•-•--•--•--------•------...----...------------•------------------------ ...._.. .-.. - •------- •------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- ------------------------------------------------------------------------------------- -------------------------------------------------------------------•-------- •------------------------------- ----------------------------------------------------------------------------- - l FINAL INSPECTION BY:. ----------------------------------- Date-.--- j 2.---- i ------------ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stresf 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -4 +asggs ATWCOD