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L-,Q ke5`tc e APPLICATION FOR SANITATION PERMIT Permit No. J1-6_.2S7 (Complete in Duplicate) �.�e This Permit Expires 1 Year From Date Issued Date Issued ___�. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein o scr This application is made in compliance with County Ordinance No. 549. ,ry JOB ADDRESS AND LO�CATION_._..- l __f, j__C _..__`T'�'-��C.l�_ _ ?�Q_ �/,lJ/2_ �',V4/'`'._ Owner's Name..-- /--- / - ---------------------------- Phone...................... , Address__. /� ' 6!-'- ----•--- . Contractor's Name------ --------------_�J_ 1 _.( -t<�_ _ ��'_G ZZq_-- e-- Phone d "4.�Ct-- Installation will serve: Residence ®/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-___ Number of bedrooms Number of baths j___ 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 oam5Z . Clay [IAdobe[f—Hardpan ❑ Previous Application Made: Yes E] No E] New Construction: Yes El No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) S T Distance from nearest well_________________Distance from foundation--------------------Material---------------.................................. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity- •-------------------- Disposal F• Id: Distance from nearest well__j.00__(__Distance from foundation...../E1_ _...Distance to nearest lot line---1:671.... 0 NeW) Number of lines.....__---------------__ ------------Length of each line_ZZ^__ ___ Width of trench-----t5_6_��_-_..._ O Type of filter material..__._ ------Depth of filter material------ _._-_-__Total length........... Distance to nearest well_Q+4AIS0 _Distance from foundation.....AIN- 'tf.Disfance tp nearest lot linees_�`""'!"► ' " Number of pits-------/------------ � -__ _-.Lining material Diameter_=� _ff"' *_ Depth_____ __________________• Cesspool: Distance from nearest well____.._•-_.____•-Distance from foundation-----------_--------Lining material______--__________..______________-_. ❑ Size: Diameter--------------- ---------------r-Depth•.•.. --..---• -...----•-------------------.-Liquid Capacity--------------------------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------__________________-___-_____-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------•----•---------------------------------- Remodeling and/or repairing (describe)---- ------- ------------------- -••-------- ------------ ............................ •--------•------------------------------------ - ----------------•--------•------------------------------------------ - -•- - ----- ---------------------- I hereby certify that I have prepared this application and that the work will be one in accordance with San Joaquin County ordinances, State law pnd rules and regulations of the San Joaquin Local Health District. ✓fib (Signed)--------------- �'/ -��---�`----- ----.._.-----•----------------------------------------------------�----- --------------------------------------(Owner and/or Contractor) SEPTIC TANK SERVICE e[Jct By2"-6-Wmr-Ave:-,-tip:-Z� 415---------------------------------------------- 0---...(T'itle)--------------------------------------------- -- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - -C- --------------------------------------- DATE--- t r -- � ------------ REVIEWED BY---- - ---------------------------•----------_.------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------- ------ DATE--_------------------------------------------•-••--•-----• Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------•--•-----•-•-•----•----•---•--•--------•-••--•-•-•-----••--• ------------------------------------------------------------------------------------------------------------------------------------------•---------•-•••...•••--•---•------•-•••----•----•---•-----•••-••----•--•-------..... -------------------------------- --.............................................._..-------------- ----- -------------------------------------------------------------------------- FINAL INSPECTION BY:..--- - ---------- ----_------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.