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APPLICATION FOR SANITATION PERMIT Permit No. "e_ F�___ / (Complete in Duplicate) -- " A , lica+ion is hereby made to the'San Joaquin Local Health District fora permit t pate Issued This application is,.mada in compliance with County Ordinance No. 549. �� u C)&0 ~�� p o construct and install the work herein described. �3S2-� JOB ADDRESS AND OCATION__ _t r� �-�-_ --------- - , --- _ - ------- --- - -Owner's Name_-------- - --------- Phone ----•-------- Contractor's Name C ` � - --•-•-- -- - ._ • "-------- - phon 70, Installation will serve: Residence A artmenf House ❑ Commercial Number of living units: " ❑ Trailer Court ❑ Motel ❑ Other 0—&?/&— Water Number of bedrooms _f"_ Number of baths �^ � /- Water Su I Publics stem J-- Lot size _____ __-_-_ Y ❑ Community system ""____/--"�"{--- Y Y ❑ Private epfh to Water' Table Characterofof soll to a depth of 3 feet: Sand � 1 ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay- Y ❑ Adobe ardpan Previous Application Made: Yes ❑ ❑ 'No ew Construction; Yes !o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) Septic Ta�ki Distance from nearesr well No. d"- .__Distance from foundation__ Material No. of compartments-- _- '_ �r -"----Material__"Z------ Size X .S^9 f-1 Liquid depth - - '/ Disposal Field: Distance from nearest well- �*� -_Ca acit //d� cC�1 -�--Distance from foundation- s • J Number of lines_f-----pf" ,, �� -------Distance'to nearest lot line...._ -_ .. Length of each line_ =Q Width of trench." _ ,., Type of fitter material_ •er �- r--� ' f� See a e t: , Depth of filter material-__.-/r_ ------------Total length-__-- p""�" l p 9 Distance to nearest wd1 � "_,`"_pistanc� rom foundation__. ! pi ce to nearest lot line_.__ / . W Numoer.of pits r_____ ining material__ ..__th Size: Diameter--"-_ . �f 1 N Cesspool; Distance froi:n nearest well_____."."_""- Deptn_ -_, .___Distance from foundation ______ Lining material""_- -____ ❑ Size: Diameter._.__I------------------------ -- Depth ----------------------Liquid Capacity...----:---- -------------gals. m Privy: Distance from nearest well.___--".-_-_- ❑ Distance to nearest lot lineDistance from nearest buildin g------------•_____________ ----- ------------- Remodeling and/or repairing (describe):_-_ ___-_--__---- - ' ---------------------------------------------------------------------------------- -------------------------------- ------------ ------------------"----•--•---- --•--•---•----------- • ------------------•-- -------------------------------------------•-------------------; r ' y -----------•-- ---- -----------------------------------•----------•-------------- -------------------------------•------•-------•-- . I herebycertify that I have prepared-this application and that the work will be done in accordance with San Joa Joaquin ordinances. St ws, and rut i �09"baf ffs of the San Joaquin Local Health District. 4 County Septic Tank Service (Signe.d} -206-So:-EIt6rcs-Ia---1140-,27046---------------------- By:__________ _"___" -------------S3ocEstars, Cas;i#. 1�11 € Contractor -------------- ---- -- _ __ :� .----(Title) _ 1 --_A------------ (Plot plan, showing size of lot, location of system in relation to w ldings, ., can be placed on reverse side). $ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- _ I . REVIEWED BY -- .. ---------- DATE----- -� ---•---------- BUILDING PERMIT ISSUED___ .... �" DATE_----------`-- ' and/or recommendations:------------------ -- DATE------- --- ----- ---•--•--------- --- ------- -- - --- ---------------- ------------ •-------- .------------------------------------ ------ ----------- ----•-------- DATE--- ------------ Alterations _.. f -------------- f` _ _ :- a � af„ -•-- -------- - ---------------------------------- - ---------------- INSPECTION C""az ----- Date------ - ----------- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 Wes+ Oak Street 1 Stockton, California 132 Sycamore Street 814 North "C" Street I Lodi, California Manteca, CaliforniaI ems Tracy, California - - 145445 ATWgpp