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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to consfruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------2341-_MGCl 23-41--Ke-Oomb------------------------------------------------------------------------------------------------------------------------ Owner's Name-------Uhaa-•-- 2oll1e-------------------------- ------------------ - ------ Phone-- }!9379---------------- Address-------------------2-741-_XCt_oxo2_3_ 4.j_XC_".;_CMb------------------------------------------------------------------------------------------------------------ --------------------------- ------------•- i Contractor's Name---.__De_1t_a._;3ept_ie-.T_ank__Sex'V1c_e-------------------------------------------------1. ----------- Phone-- 3---'�-95-5-------------- Installation will serve: Residence A r ment Ho se Com ercial ❑ Trailer Court Ek Motel ❑ Other ❑ / c4olnp and trai` ers Number of livingunits: Num er o bedrooms ❑ Number of baths ❑ Lot size-_--_____5{ 1-0-__ft_.r------------------------ , Water Supply: Public system [K] Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe [3 Hardpan ❑A-4 3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----- -_-___-------------- ® No. of compartments-----------1-------------Capacity------5 :t_Size----•---------------------------Liquid depth---------------- -{` 1 cv Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------_-----------!__ .� x ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------- C4 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------------•_-_----------_--____--_-_-_----- Seepage Pit: Distance to nearest well-_-__-__`--------Distance from foundation------G_ `�-` Distance to nearest lot line__�'a--/ � ® Number ofpits--_-_l--------------Lining material----bv_1Zk----Size: Diameter-_-__�_ _--_--Depth- Disposal Field: Distance from nearest well---------------v Distance from foundation----S�`f___Distance to nearest lot ® Number of lines----__-_-1---------------------Length of each -------Width of trench----- _' _................... Type of filter material--rCLCk-----------Depth of filter material--------/fir , 1 Remodelingand/or re airi (describe): Z __! ------rt.. / p f'g� { ) -- -------------------------- ----- -----------------•-- --_._�Z -ra. ''" l' Ti°`""- i, ---------------- ------------------ -------------- ------------- ----�-�^''�- --- -------------��----. �_ ��._�"-:---_.�-d--_`r.__�►_�...--�'---- ��--- ----- ��---fix'----�-�-� ------- -- - 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, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------7]* t.a.---fie _Lc---Tank--derv-ire----------------------------------------------------------------------------(Owner and/or Contractor) By:.... --------------------------------------------------------------------(Title)-----Q W_r1e.n'-lgSr,--------------------------- (Plot plans, showing si e o lot, lova ion of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - ----------- -------------------------------------------------------------------- DATE--------�� 13_ 5 REVIEWED BY---------------------------------------- ----- DATE------- ��= ---------------- - •---- --------- -- -- ------------------------------------------ -----•------------ BUILDING PERMIT ISSLIED------------------------------------------------------------------------------------------------------ DATE---------------------------------------•--- - --------------- Alterations and/or recommendations:---------�----/---�-------�------- ----------------------------------•-------------------------------------------------- -------------------------------------- !' `'�. ----- "t --------- ----- nr•= 'c� .^ ---------------------------------------------------------------------------------------•-------------------------••----------------------------------------•---------------•---------------------------------------------•--- ------------------------•----------------------------------------------------•--- ----------------------------------------------------------------------------------------------------------------------------- PERMIT No----41&-------- ISSUED---11---'s--- -----------(Date) FINAL INSPECTION BY------------- f- v_^_-�V% - - -------------------------- Date------------------------ /Cv SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-4-2M 9-50 W-1639 Stockton, California '�