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FOR OFFICE USE: g _ --- ------------------ '-- � Permit No.f9..a...- ----- ---- ---- --- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate] Date Issued ------------------------------------- _ ---- -----------_ - � This Permit Expires 1 Year From Date Issue 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. y o -------- JOB ADDRESS AN O TkON,_ P one.-- Owner's Name-------------------- --- Address--------------------- - - -------------------- -- --- --- ------ ' - -----------r 4- (� \ -- - Q Phone Contracto`r's am Installation will serve: ResidenceApartment H se om ercial ❑ Traile o rt lufiot ❑ Other ' � , Install �""� _ / --------- ----------- I ----------- Number of living units: -"-,-" Number of bedrooms _____ _ N�r of baths .____-_ Lotlsize , Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water.Table -------- ft. { Character of soil to a depth of 3 fee ❑ Gravel ❑ Sandy Loam ElClay Loam ❑ Clay ❑ obe❑ Hardpan ❑ 4 Previous Application Made: (If yes,date_.._-__-__...__._f No El New Construction: Yes E] No E] FHA/VA:Yes E] �No ❑ I f, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permi Sed -if sew r is available within 200 feet.) r t Septic.:Ta Distance from nearest weliNk.1istance f fouy�dati -_e-------.Matenal_.IP.__=:____-_._________________ / `� Si.,e/ ..... 1_ d P. _ -.Ca acct f/"`' No` of compartments- -_.- _-- -- - I de th.___. ------- P Y� � f e �l�1zJ_Distance from foundation��--�.---Distance to nearest lot -..--- Disposal F�iel "• Distance from near st well ____._____ LAY A j—P _ ��- ------ .-,--_ Len th of each line:" Width of trench-_ of lines. 9 ll 9 ! E Type of filter materi ---- --DeP+ of filter material___L_ _ _ __--TotaI lengthti-._<- ---------- .. �- ° ' Seepage Pit: �P Distance,to Weare t well_ ______________ tahce om oundatio�:� -.°----.Djstance to nearest lot line_' - -.- Linin' materials_ .---Size:'Diameter4e__�W -- Depth_......11-------t-----_---- Number of�pit _. - g ,, 6 - . Cesspool: Distance from nearest well----- from foundations_____________t._...Lining material--.__._____________.______T_____---. -1De} th----- --------------Liquid Capacity------------------ ---------gals. - ❑ Size: Diameter---------------------' ---"- P ° �� • - Distance from nearest:building-__----------________________.______". Distance from nearest well'=----------------------------- r Privy: --- ❑ , Distanceto��nearest lot linea------------------- - � ---'""---"'"""-"" ------------------------------------- ----- ----- f Remodeling and repairing (describe}:_--.---- ' -----x _ _ — -- __ IJ ----- ---------�?4..-- - -- '-- ---- - ----- - '--- --- --- ----- -----4------------- ---------- --------------------- -- -------- ---------------------j--------------------------------------------------------------------------- I hereby certify that I have p%epared this application and that the work will 6e done in accordance with San Joaquin Coun+y ordinances, State lavs,- ft _les a;d regulations of the San Joaquin Local Health District. ` t. § � y -------- ----------' ----- (Signed)---------------- ----Si Wed -=-- - --- 11. ------- ----- SEPTIC TANK SERVICE ------------------ -------(Title)-- ----------- ------------- --- ------ -- - ----- By:----RA-1S-JEiMiller 8:""� A R'.6-38 `(Plat plan, showing size of lot` 1ocaglon o'��System in rete+i to we ildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----- = -- ----- ------------ --------------------- DATE-- - f $�-------------1 --------------------------- DATE------------------------------- REVIEWEDBY--------------------------------------------- ----- ----------------- DATE--- ----- ----- --------------`---------- BUILDING PERMIT ISSUED------------•--------------------------------------------------- - - ------ Alterations and/or recommendations---------------------------------------------------------------------------------- ----------------"---------------- ---------- --- --------------------------------------°------------------ ---- -i ------ -- --------------- •------------------•------------------------ --------- i - -------- -- -------- r�C� --- ------------------------ Date` 5f FINAL INSPECTION BY:...O��----- - -- -_ --- k1 SAN JOAQUIN LOCAL HEALTH DISTRICT j ,.t 124 Sycamore Street 205 West 91h Street 1401 E.Hazelton Avo. `, i t � 300 West Oak Street y Manteca,California Tracy,California Stockton,California„.. Lodi,California