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F FOR OFFICE USE: ., J�S-r017---"---------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- Date Issued - ------------------------------- (Complete in Duplicate) ------------pp---- - - ---------------- -- 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. a _ ------------3 �s JOB ADDRESS AND LOCATION_ I- ' ' f p - - --- Phoneme -_..--- �---------------- _E y -------------------- - ------ -------------------------- Owner's Name------ Address--•------------------- Contractor's Name •--- -------------- ----- - ---- --------------- - ------" Installation will serve: Residence �artment House ❑ Comm'rcial ❑ Trailer ourt ❑.�M^otel/❑------- Other Number of living units: __/_-_ N ber of bedrooms Number of baths _ --___ Lot size Private ❑ Depth to Wafter Table ___-__.- ft. Water Supply: Public system Community system ❑ Clay ❑ Adobe lardpan ❑ Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ll Clay Clay ❑ No Y FHA/VA: Yes ❑ No ❑ Previous Application Made: tlf yes,date___-------__-------_I No F1 New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1--- ----- -.Mater�al- Septic Tank: Distance from nearest w 11 --Distan fe fr u tif(n__ -Ca acit A� 4 - Size.�_._7A��f ��Liquid depth__----------- P Y �"�P No. of compartments.___ "----------- - i r Disposal Field: Distance from nearest well.l�.fJ�&!e.-Distance from foundation.-�-d-- -•----Distance to nearesrrt��lot 1�r e_____-.----"---- Number of lines- ."�_____ _to ___ Length of each line__ `� ------Width of trench 6t------------------------ , j< Depth of filter material_----�-- ------`-----Total length-------------------.. - ------- Type of filter material- -----t -----____.Distance to nearest lot line__-_--Seepa e Pit: Distance to nearest well _ —P.-----Distance from foundation /� Dep - -P------------- Number of pits---�__-_._-.____- --Lining material-PS�,Q ------ _Size: 'ameter- 4-60 Cess Cesspool: Distance from"nearest well_______________Distance fronfoundation._._-______---____.Lining materia-----------------------------------.- t p 1i uid Capacity ___-____---gals. ❑ q P Y Size: Diameter'-�-----------------------------------Depth_------------------------------ ------- ---- Distance from `nearest well------------------------------------- ---------Distance from nearest building-________-------------------------------- Privy: ; --------------------- ❑ Distance to nearest lot line------------------------------------------------------------------------------- ----------------------------- ------------------------------ ----------------------- - --------�X-« ----------------------------- Remodeling and/or repairing (describe):____ --------- J�---- - ----- ---- ` / ----- •-------•------ I -------------------------•--------•-------------------------------------; i I hereby certify that l have-p-re pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anMules and regulations of the San Joaquin Local Health District. i C� rI ��g ,Contractorl a/Jai hE----------------------------------- -------- ---- --- ------ ----- (Signed)-------------------------- ------------- SEPTIC -TANK 9FRVICE -" (Title)-------------------------------- -------- - -- ------ ------- ------- ------ 2415_E__Miner-laue., ' -6.384I----- (Plofi plan, showing size of lot, 1ocaion of system in relation to wet ,tuilJiiings, etc can be placed on reverse side). :; F R DEPARTMENT USE ONLY DATE -61-- -------------------------- - APPLICATION ACCEPTED BY-------- - ---------------------------------- " - ----- --- DATE------------- ------------------------------------------- REVIEWED BY----------- -- ---- - -- --- ------------------------------ -= DATE---- ------------------------------ ----------------- ----- BUILDING PERMIT ISSUID---._______t-.____-__ 4 ------------------- Alterations and/or recommendation : T - -- -- - ---------------------------=----------- -- -- ---------- ---------- ---- -------- ------------------ - -------------------------------------- - -- Date--._ . _ ,( u- - ----------- ------ - 7� FINAL INSPECTION BY:.---"--- i SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CQ.