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I--UK UI-1-K-L USE: " �------------------------Qd p _ ___ ----------------------------------- -------- ------ APPLICATION FOR SANITATION PERMIT Permit No. 5. ......./..... � ------------------------------------- -- ---- ----- (Complete in Duplicate) Date Issued 40._-�` � --- ----------------------------------------------- - --- 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 /ASND LOCATION--------------- - ----� ;-=-- - - - _ ---------- Owner's Name_.L- ". ,, �G? fes-'---------_---------•-•----- --------------- -------------------------------------------- Phone_4if'6AT_-_f_1: Address-----------1. � ------- ---- - L ,- ® Contractor's Name--- -•- � Phone_ Installation will serve: Residence par m t House Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ______ Nu ber of bedrooms __ "' Number of baths -_�_._ Lot size __-��!_.��1.'_.�-�-�__ _______________ 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 Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ N FHANA: Yes ❑ No ❑ � 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S�c . Distance from nearest well_________________Distance from foundation Di al _ foundation-__._-_-__ ___._.__.Material---..____..._.. No. of compartments---------------_--- -Size_________._._____------••----_ Liquid depth____.__________ ----------Cap.__a Capacity Distance from nearest welW) Distance from foundation__ Q._ _-__ Distance to nearest lot line___ Number of lines________ Length of each line___,.._- _ ____ -___-Width of french__-t �!----_------- _- Type of filter ma r? Depth of filter material....../?W.Total length--------------_-:_ ag Pit: Distance to nearest well__ Distance from foundatiorr�-------------Distance to nearest lot line----------------- Number of pits_____________________Lining material----------_------______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----------.------------------------------- F _.____________ ._.❑ Distance to nearest lot line-------------------- ---------- Remodeling and/or repairing {describe):---------------------- - ------ --------- ----- ------ ----- -- ----- �i------------------------------------ ------------------------------ --------------------------------------------------------------------------------- pa -f� �..c ----------------------- -----------------------------------------------------•--------------------•-------------------------------------------------------------------------------- -------------------------- 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, rules and regulations of the San Joaq ' ocal Health District. (Signed)-------------- a Cs ��jF& ------------------------------------------------- -- ------ - ------ - --------------- •------- --------- Contractor) SE1'7fC TANK SFRVIS<!?------------------------- - gy 2s��a-1:Afi'nztr ; : : � �� title) --------------_ ----- {Plot plan, showing size of lot, IVoc);3i df system in relation to a buildings, et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----Gf�� ------ -- -- --- ---------------------------------------- DATE---------4-4-—O REVIEWEDBY-------------------------------- ------------ ---------------------_ ------------------- -------------------------------- DATE------ BUILDING PERMIT ISSUED--------------------------------------------------------------—------------------------------------._ DATE Altera ' and/or recommendations:_ q _______ ___ _______ ----------- --------------------- -------------------------------------------------------------------- ------------ ------------------------------------- •---------- -------- ------------------------- ------------------- ------------------------------------------------------- ------------------------- - ---------------•----------------------------------------------------------- FINAL INSPECTION BY: ..N.. ----------------- Date....... -------- SAN ------SAN JOAQ UINZL 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 F.P.C❑.