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FOR OFFICE USE: uj� I APPLICATION FOR SANITATION PERMIT Permit No. 30 (Complete in Duplicate) ---------- - --�---�--------------�------------- -- ' �. ;This Permit Expires i Year From Date Issued Date Issued ----- � d Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. _ E C' 4 JOB ADDRESS AND, LOCATION _��_��_� { ----------- Phone-------•................ Owner's Name---�'�-�'__--------- �Ez --�----�4-------- - ------- ---�- - ------ ------- - - ----------- s � ' Address----------------------�---�-••--• ----� 'C-1�-� ell Contractor's NameC ..: U cxk+__� --------------------- Phone.Phone-•-- - ---z- n2,56 Installation will serve: Residence E] Apartment (louse E] Commercial [] Trailer Court E] Motel ElOther ❑ �'-� Number of living units. '� Nu - mber of bedrooms _'_:_ Number of baths ________ Lot size _,! ____�__ �................ -+- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table __:)ft. a Character of soil to a depth of 3 feet:- Sand-❑ .-Gravel`❑-Sandy Loam ❑ Clay Loam E]--Clay ❑-Adobed�_kiardpan ❑ i Previous Application Made: (If yes,date---,-------------'--)' No New Construction: Yes' o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF .INSTALLATION AND SPECIFICATIONS:•. (No septic tank or cesspool permitted if public seurer is available within 200 feet.) 1 Septic Tank: Distance from••neare-st well__r`t Distance from f undaticn_/�____-Material___.__-- " _-_..___��.. No. of compact 1 nts_.._ _-�_:5ize_ _: :___ Eiquid depth___4757.4"!------Capacity... Di osa field: Distance�fro'n�nearest well_��Ma _,Dis ante from found .. .. __ation. .-__._____Distance to nearest lot line_ ________ Number of lines_-_.______ Length of each line____ S_�_ ___.d Width of trench---- ,c Type of filter material_ :��"�DepfkNof filter material___._ __�_ -----Total length------�""��-�________-___-__ Distance to neo e'st we€ ,�`�Ka 'i 4'?-___1].istanC from foundation=__ __.Distance to nearest lot lin e.__ _ ------ page � Number of pits-�!_E_�______________Lining material____�_�[?___:_ _- Size: Diameter_____. rr�__-Depth-._, _s___.______, �- ,, _ cn ;, ft �- a Cesspool: Distance f'r6:m,nearest well----------------Distance from foundation----- '__---------- Lining material---------------------•___------------- ❑ Size: Diameter- 11---•-------=-------- ---=--Dep"th-------------- -----------------------------------.-Liquid Capacity--_:,, Ir Privy: Distance from',nearest well________________________ ______ ____ __---•__:Distance from n barest buildingI, Distance to are lot line___________________ _ ----= - ----------�-----------' ------ e, --- Remo in and or re ai'rin escbe �- -------- ---------------- ------ ---- -� ` -----------------------------------------------i ------------------------------ I = Q F I hereby certify that-�1 heve'prepared this 1ication and that the work'wili'be don _eaccordance with San Joaquin County ordinances., State laws,' rules and re i11,flozQ9f fhe'San Joaquin Local Health District. (Signed) _ 4P..T T g '= , t ( _Contractor) - By-SEPTIC THINK 905�.Miner Ave: -SERV! t ) k 905 E:. �0:2J Title (Plot plan, snowing size o 'tit ��a 6f system in relation to wells, bui ngs, etc., n e pieced on reverse side). r FOR DEPARTMENT LAE ONLY APPLICATION ACCEPTED BY-- = -- --------- DATE REVIEWEDBY------- ---------------- ------- ------------------------------------------------------=-------------------------- DATE-------- BUILDINGPERMITISSUED--•--------------------•-------•--------- -----------------------------------=----------------------- DATE------------------------------------ Alterations and/or recommendations ______________________ -- --------------------------•---•--•------------------........••------------------------------------------ •----------------------- ------•------------------------------•--•---- ---- --. u --- -------------------------------------- ------------------------------------------------- •------- - ------- ------------------------- ------- -------- ----•----------------------------- -- ------•--•--------•------ ------------------------------------------•----------•------------ - f FINAL INSPECTION BY. � .----- Date`-----_-f.-_---- -', :-G ..SAN=JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weet Oak Street 144 Sycamore Street ! 2 5 West 9th Street" Stockton,CalifornialOdfCalifornia Manteca,California «. Tracy,California E9-9 REVISED 8.59 r.P.co.1M 6-60 + Y$