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FOR OFFICE USE; �l T APPLICATION FOR SANITATION PERMIT. f Pe it No. ----------------------------------------- - ----- ---- - (Complete in Duplicate) .. .� r— y Date Issued ________________________ __:..__..____.____..__ This Permit Expires']-Year From Date Issued ._---# Application is hereby made to the San Joaquin Local Health'District for a pe�mit-to Q_nstruct'a d,install fFtQ work herein described. This application is made in compliance with County Ordinance No. 549. A4-%,— I'eALOF" JOB ADDRESS D LOCATION' !.�R _ _ _ _ i _ J __ ��r¢..�_:fid`---=P.�------ Owner's Name-A �,a`{�---- ----aw-wuwf:• __. ' s ----- ---_---------------- Phone_ Address__1__l[_�i'�►-- ------ ±---A---aI� -- - -------------------------------f' M -- ---- Contractor's Na - `' tS�J- r,� --- --- ----- -= Z'J✓ �+��47. _ T_S_ � /f r Phone- Installation will serve: Residence [ 'Apar m t House ❑ Commercial ❑ Trailer icourt ❑ Motel ❑ Other � Number of living units: �___ u er-of:bedrooms ________ Number of_baths �'-Lot size ________ __________________________________________________ . - s Water Supply: Public system F1 Community system F] Private 5epthFto Watei 7able _Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan -Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes ❑_No. FHA/VA: Yes ❑ No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available ;thin 200 feet.)iL " Septic Tank: Distance from nearest well/_400 __Distan f o .-..jA&f r'aL__ ___ _ _ �_ p l � 4r') `lam ti - - ----- No. of compartments Size_;b� ,_ 5! 3'- e,P.th--;�70� Capaci mit t 73 x I} t. :: ...- -- Di al Field: Distance from nea st well __Distance from foundation___ __._ - ____.Distance to nearest lot-line____o2 !� Number of lines.____ _ __. _______. _Length of each lin �'� �_�. /�dth of trench------' - �r_ Type of filter materia _Depth of filter material__�__r�_`L______Total length__-__a-s",------------------- s __ __-- __-- � ^ $e ge Pit: . Distance to neares a4,."i oundation_ _�_.___.Dis n to neares# I t Distanc rim Number of pits--- ---.--Lining material _ Size: Diameter_- .... Dep#h.... _____________.._ ti Cesspool: Distance from nearest well-----------------Distance from oundation.:.__._._.:._._.___-Lining material-------------------------------- -_.-. ❑ Capacity_� Size: Diameter--------------------------=-----------bepth--------------- --------------- - - ______________..Liquid ------------------------..gals. Priv Distance from nearest well---------------------------------------------2--Distance from nearest buildin- ------------ --------- ❑ Distanearesne------------------------------ .nce-to t lot li ,_----------::------------------------- Remodeling and/or repairing {describej_ ____ ______ __ ---------------- --------- ------- -- w..-------.----------------- y --- -- ---- '�- ------- --------------------------------------------- ------ ---------------------------- -- -------------------------------------------------------- ' I hereby certify that� have prepared this application and that the work will be.doneLin accordance with San Joaquin County ordinances, State CClaws, m ules /and regulations of the San Joaquin Local Health District. (Signed)------- - -------------------------- r Contractor .sr= li:--TATM-"SE!fR"C E------- - _ I By; 2915 E.Miner Ave_, • HQ-6.3MI . ---------•-•-•--------------------------------------------- - -- - ------ ----- ---- -------- 1t e)------------ &r ---------- I (Plot plan, showing size of-lot, location of system in relation to w Is, buildings, c., can be placed-on reverse side).` .' FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY--------- - --------------------- ------------'----------------------------- DATE------ - REVIEWEDBY--- ---------------------------------- --- --------------------------------------------------------------------------------- DATE----------------------'- --- ------------------------------ - ------------------------ BUILDING PERMIT ISSUED----- --------- DATE----------------- -------- Alterations and/or recommendations:- fo ��,---------- .......------ --- -V----1- -------------------------------------------------------------------- -----------------------------•------------------------------------- ....... ------- `- ------------------------------------ -----------------------------------------------------------------------...----------- -_ ----------------------------------------------------------------- ---------------------------------------------------------- ------------------------------------------------------------------ --------------------------- ----- ------- -------------------- -------------------------------------------• --------------- -------•---------------------------------------- ----------------------:-------------------- ---------------------- FINAL INSPECTION BY------------------- -- ��-------- ------------- Date---------' �� /.` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street �* 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California fi Manteca,California Tracy, California F.P.CO.