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1-UK UI-rlC.r USE: _ 10 �� ----- ---------:3,2 ----------------- ------------------ ----- c'Q--------------.-_ APPLICATION FOIR SANITATION PERMIT Permit No.o 1 ------------------ ---- --------------------------------- (Complete in Duplicate) Date Issued -------------------------------------- This Permit Expires 1 Year From Date Issued Application 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 LO A N , -- Owner's Name------------- hc _ . (R Address I_,.1—3_ .._• -�, Gl _fx!4 P - - •-----•---- Contractor's Name__ - -�--y , k +�� ---�T% qk� -- : C t--------- --------- Phon e"` Installation will serve: Residence m,�parfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _��iumber of bedrooms _-�4 Number of baths rY Lot size _ �"''' - _e------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date- ---- ---------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (Naptic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Tan from nearest well________________Distance from foundation-------------------Material----------------------_--------------------------N-�o No. of compartments--------------- ----------Size-----------------------------.-Liquid depth--------------- - -.------Capacity------ ----- os field: Distance from nearest wellAllm--� --Distance from foundation__�_�_f--------Distance to nearest lot line_.-/�_--. Number of lines-----!____ _____________ Length of each line------ '____._____--_.Width of trench sf Type of filter material Depth of filter ma of vial----_� Total length---------------t ---___--___. �/�,,,, { SeeV Pit; Distance to nearest well_ e!!tl-e__-_--Distance from foundation---__'�^[r_'_�_.Distance to nearest lot line____�_Q�. Number of pits---I-----------------Lining material--f? -----.Size: Diameter_- - - -----Depth_--------------------------- ----• 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------------------_______________-_----- 0 Distance to nearest lot line--------------------------------- ------------------------------ Remodeling and/or repairing (describe):---------.-------.__---- ____ ____ __._ --------- ----W;Az l �/-l_'t�-------------------------- ----------------------------------- -----------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------- 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 d rules and regulations of the San Joaquin Local Health District. (Signed)-------------2eay--&-yi94t------------------------ ---------- --------------------------------------------------------------- - -------(Owner and/or Contractor) I3 SEPTIC TANK SERVICE � Y2915-E:-Miner-Ave.-,-----Ht3:u-3641--------------------------------------------------------------------------------(Title)---------------------------- ---------- ----- -- ----- (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 ---------------------------- -- DATE---------- REVIEWEDBY--------------------------------------------------------------------- ------------------------ -- -------------------------- DATE----------- BUILDINGPERMIT ISSUED---------------------------------- -------------------------—------------------ ------------------ DATE------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------- ------------------------------------------------ -------------------------------- -------------------- ---------------- • -------------------------------------------------------------------------------------------• ------------------------------------ ------------------- ----------------------------- - - ------ -------------- --------------- -------------------------------- 4 FINAL INSPECTION BY;---- - - - ----------------------------------- Date---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelfan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co. f `y 1