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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT Permit No. ... f-_1-_33 ----------------------------------------------------------- (Complete in Duplicate) -------- -------------------- --- --- --- - (Comp - Date issued . -•_-- -_131 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Di for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. JOB ADDRESS D CATIO --- ---- --- - - -------- --- ---- -- ---------------------------------------- Owner s Name- ---- -- ------ - - -- --- - -- - � - -- -- PhonePr�c. ^-- lr -- -- --------------------------- Address-------------L-T ------------------------------- ----- -=---- ------- - -------- - -• ------------------------------------------------------------•--••---------------- Contractor's Nam __ 0,77c ------------------------------------------------------ Phone____!'7.D6 _~ Installation will serve: Residence ❑ Apartment House F] 'Commercial ❑ Trailer Court ❑ Mote! E] Other Number of living units: __ _____ er of bedrooms _ Number of baths ________ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table :19ft. ` { Character of soil to a depth of 3 feet: Sand ❑ Gravel - Sandy Loam ❑ ClaY Loam ❑ ClaYAdobeL9andan ❑ Previous Application Made: (if yes,ldate--------------------I No ❑ New Construction: Yes ❑ No-AA-FHA/VA., Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p,rmitted if public sewer is available within 200 feet.) ryry c Ta Distance from nearest well-----------------Distance from foundation---------------._._.Material---_--------------------------------------------- 1�' No. of compartments-------------------------Size--------------------------------Liquid dept --------------------------Capacity-- d: Distance from nearest well_ ,#1 _e_Distance from foundation-_ _______.Distance to nearest lot line_ _' Number of lines'_.__._ Length of each line�O__C__ _______..Width of trench cri!�____ f} Type of filter materia ._ _ __Depth of filter material__._ Total length___.__ ____________________ age i : Distance to nearest well_/ ______Distance f om foundation----/__.___ Distance to nearest lot line__-=W_.. Number of pits-0. ----------------Lining material---- -P_ _ . . -_----Size: Diameter_..�1� « Depth-- -1.______._-__-- n { Cesspool: Distance,frem nearest well________________Distance fro foundation._.___..__..___._�__Lining material........ Size: Diameter-- ---------------------------------Depth----------------------------- --------------------- Liquid Capacity- ---------------------- -gals. Privy: Distance from nearest well ____.__._._-___-------------_----------------_____Distance from nearest building.___._.__________._______________.__._._. ❑ Distance to nearest lot line---------------------------------:--------------•------------------------------------------------ --------------------- Remodeling and/or repairing (describe)------------ --------- -- ---- ___-- _ -------____-- -- /A -- _ t ------------------------------------------------------------------------•------- -------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the woik will be done in accordance with San Joaquin County ordinances, State laws, anc�fules and regulations of the San Joaquin Local Health District. J ontractor t (Signed)-------------------� �'---- - -- ) l__5-C, TANK---ERVICE-------------------/ion -----(Title)------------------ BY -----29i�€; - - (Plat plan, showing size ofYol; lothqicthi;ystem in reto wells, ildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. IV = = 140- DATE -------1----------------- i REVIEWED BY ----------- ------ DATE. •---- --- BUILDING PERMIT ISSUED--------------1-------------------- ------ ---------------------------------------------------------- DATE Alterations and/or recommendations._.._-_.__._ ! :. ----------------_------------------------------------------------------ ------ ------- -----------------------------------------------------------------------------------•----------------------------•---•--•---------------- 1 1 t ------------- -------- -------------- ----- --- ---------- -----------------•----------------•-----------------•--------- ------- --------- - ----------------------- -------- --------------------- ----- ------------- FINAL INSPECTION BY:--------- '` ----------------- Date-- ---------�_ �� ---7--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.