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FOR OFFICE USE: ---------- ------- ------------ - --- ---------- - -------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�.�- �-Z ---- ------------=--- -- -----------.-------------- (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. JOB ADDRESS AND LOCATION--- --- 4 'n '_._of_. rsanCDavies---Road--------------------•--_- --- ---------Zodi------------ R.i..Lind t EN 96593 i Owner's Name ---- -•---------------------=--------------------------------------=-------------------- ---- Phone...... = 1 Rt. Box44- ri Address__________________ 2__ _ � _--_- Contractor's Name----EY'137 --t S Septic Tank ServiCf� Phone----------------------------------- Installation will serve: Residence :] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _1--- Number of baths 1----- Lot size __Ajc:r!eage--------------------- Wate`rISupply: Publiclsystem ❑ Community system ElPrivate [j Depth to Water TableZQ__._ ft. "�7 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam JE Clay ❑ Adobe❑ Hardpan ❑\! ) �` Previous Application Made: (If yes date-..-.----------- ..) No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ TYPEiOF INSTALLATION AND SPECIFICATIONS: �(No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic_ Tank: Distance from nearest-well 5fl 'Dlstanse from foundation_.._ __-__-_Ma�erlal--0O3 C ' �-- - __-- �] No. of compartments-_ _.2--.---.. -------Size3�___x9_-_x---5_.--__--Liquid depfih..._4 - --------------Capacity-�?OO---gal*! I K f t Disposal Field: Distance from nearest well.------SQ.r..Distance from foundation-----__IQ..._.-.Distance to nearest-lot line----- Number oflines----------1------------------- Length of each line-----ZC0-t--ff----•-----Width of french...... �_ � Type of filter,material___S_e.P_. Q0kDepth of filter material--__3.-$___---------- length----Z0�)__-------------------------- = i See age Pit: Distance to nearest well----------- --------Distance from foundation..-.___=----.------Distance to nearest lot line----------------- p Number of pits------ ------Lining material-----------------------Size: Diameter-----------------------Depth-----------------------`-------- Cesspool: Distance from nearest.well___.. .----------Distance from foundation--------------------Lining material_____-.---------------------_-_---- ❑ Size: Diameter-_-)--=---- _------I-----------Depth-.---------• ------Liquid Capacity------------•-----------=---gals. M ---------------------- - � Distance from nearest building_Distance from nearest well------- ---;':-�- ----.-------•------ --- - -- g---------------- - ❑ Distance to nearest lot line-----------------------.___ _------------------------------------------ .. - -------------- Remodeling a*RX (descril,36l:'�N---.Aband_on___-exiating---sap-ti-c_. tank---syrtem-----------------------------------=---------- - " e11 -- -------------------------------- -------------------------- ------------------- --- - ; ---------------- -----t---------------------- ------- ---------------------•-------------------------------------------------------------------------------------------- _ ' ---------------------------------------------------------------- I hereby certify that I have prepa ed 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. I vett Si ned x'n D ep t-- ank----5erY. _eE_._. ---------- - ,nd/or Con or] .� B r � ------------ ---------- --•-----------------j-(Title)----------- '--- ----- . Y� rt (Pia# plan, showing.size of,lot, location_of,system.in relation.#a wells, buildings, etc, can be placed on reverse side]. J �. -1-- r fir . . ••*. ' <! µ ,; ti FOR DEPARTMEN.LUSE ONLY . t ,vim , , - APPLICATION ACCEPTED BY - ------------------ ----------- DATE . _' - . REVIEWEDBY------ ----T------------- -------------------------------------- ...... --I------------------------------- -------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--=-------------=-----=------------------- ------------------------------------------------------------ DATE_----------------------------------------------------------- Alterations and/orwrecommendations* ---.-- - 'Y " -� --- --------------- 1 - - -------------------------------------------------------------- y ------------------- ---------`----- --------------------- :• ------------ . -------------------------------- : �` JJ FINAL�fNSPECTIOhE BY: - - =-------- -- Date (/. � ---- ,.� . -�, SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED a-59 3M 8-'63 F.P.CD.