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Y APPLICATION FOR SANITATION PERMIT Permit No. (Complete (Complete in Duplicate) Date Issu0t Applica-1,ion 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 ANDD OCATION.------- - -------- _ -------------- - Owner's Name.. �l t'� Q 4 r _ -- �� f -- - ----------------------------------- Phone_ : Address``L.�. . `, k-------------------- - ----------------- i Contractor's Name__._��Z7 V.. 1 °� �t------ ---- " - C •------- -------------- Phone.. Installation will serve: Residence Apartment House ❑ Commercial. ❑ Trailer Court ❑ Motel ❑ Other E R Number of living units. __ -- Nu ber of bedrooms __Number of baths __f Lot size ______4 _^--- :-�. --------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table }_�tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ta k�4;rp�)t,lc�: Distance from nearest well------- ----------Distance from foundation_ __________________Material_____--__._____.__--_,.___________________-. No. of compartments-------------------------Size-. - ---.-Liquid depth------------- ------------Capacity--------------;`* .-. 1 al posaI Field Distance from nearest well------------ -_Distance from foundation____________________Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line-------------7---- ----------Width of trench---------r------------------------- Type of filter material-------------- ----------Depth of filter material-..................___Total length_________-__----______________________ I � Seepage P'.: Distance to nearest weII j,t4_N.5__-_Distant from foundation---.I----- ---------Distance to nearest lot line--.- --------- --Size: Diameter_-- r ' Number of pits----!__....__-._____Lining material----------�__-_ -� ----Deptn----�-� Cesspool: Distance from nearest well_________________Distance from foundation...._-_-_-.._._---_Lining material__._._________..._.__.--_--------- _. ❑ Size: Diameter------------------------------ ----Depth---------------------------------------------__Liquicl Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.-_._________--___..._.-_------ ❑ Distance fo nearest lot line-------- ---------- --•------------------------------------•------------------------------------------------------------------------ Remodeling and/or repairing (describe):-- ------------------ ---- ----------- ------•-••----------------. ----------• •-----------•-- ---------------r-----------•--•------------------------ -------------------------------------•-------------------------------------------------------------------------------------- ------------------------------------------------------------------•--.----------------------•------------------- ---------------------------------------------- --- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and ruleMe } s of the San Joaquin Local Health District. ' gW Septic Tank Service 1___ ----- �rw Contractor (Signed) T=-StI,:-IEldoim-do---140 2=9i34�s E By:.. ------•----------------sui4 nl-Cal4f.-------------- � (Title)------ � - --- --------------------------------- -- -- -- --- ---- --- ----------------------- (Plot plan, showing size of lot, location of system in relation o well , buildings, a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ----------------------< --------------------------------------------------- DATE--- ------- ----- -------------------------------- REVIEWED BY------------------------- -------------- -- ---------��`' ------------------------------------------------ DATE--------- '�` ------------------- �3 BUILDING PERMIT,ISSUED---------------------------I---- - �' DATE------------ F----------------------------------- -1�------------------------------- Alterations and/or recommendations----- ------------ -=------ - ---------------• ---------------------------------•-----•-- •------ - -- I's----------------------------- ----- ---------- -------------------------------------------------------•---•---------------------•-------------------------•--------------- ---1------------------------------------------------F-------------J-�--------i--------_-- ------------------------------------ - -------------------------•----------- - ------ 1 FINAL INSPECTION BY::-_ ----------------------------------------- Date--- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California EE9 145446 ATWOOO