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1^ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ (Complete --- ___----.5----(Complete in Duplicate) 4A Date Issued ---_.�/. AZ_ Applica*ion 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. �� i •Z �V � ` --JOB ADDRESS AND LOCATION---•- -. - .- _If_ /----------- - - - Owner's i Name.-•----/ ;� ------ --•-----------------------•-------------------- -------------------------- ------ ----------- Phone.l.�'u 1,61 Address.- ------- - t •��---------------- / 1 Contractor's Name----..L" --f- `j��u- -----��-_- '----��-__._�C_.---------------------------- ------------ Phone__ ._�Z-7&V__6 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail' r Court ❑ Motel ❑ Other ❑ Number of living units: _/__._ Nurnber of bedrooms 4__- Number of baths _ _ Lot size _ r V---------------- Water -------------Water Supply: Public system Community system E] Private E] Depth to Water Table f73d�4� Character of soil to a depth of 3 feet` Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No I flew Construction: Yes P,110 ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p lic sewer is available within 200 feet.) qk. ._Distance from foundation__ 4 Septic T Distance from nearest wgll__'__ ___ ��_._____.Matenal__.____ ____- �,- .c_------ , [ No. of compartments-----y-------------------Size---------`f _3�' .�_.__.Liquid depth_re'X '_...-------- p y- Disposal field: Distance from nearest well- -t4m-c Distance trom foundation---{-cLl_..__.._Distance to nearest lot line......' . [�� Number of lines___�__Y ._.__.__ . __ Length of each line_ ,r'.__�___,___-..Width of french.---.;—:, '�_______________ Type of filter material- - p "�___._Total length__- ______ - - - _S'De Depth of filter matenal__.___�__- _ _____________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------............Distance to nearest lot line__.____________._ n ❑ Number of pits----,----- ------Lining material-----------------------Size: Diameter------------------.---.Depth--------------------------------- 2U, TIN Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material--____.___________.._______________-_ Size: Diameter---- °------------- ------------------Depth----------------------------- ----------------------Liquid Capacity gals. Privy: Distance from nearest well____-----_---_---------------_--------------------Distance from nearest building------------------------------------------- I ❑ Distance to nearest lot line---------------------------------------------- ------------------------•--------------------------------------------=------------------------ - i Remodeling and/or repairing (descril?e):---------------------------------------------------------------•------------------------------------------=------- •----•----------------------•---.---- -----------------------•-------•-----•-------------------- =-•--------•----------------------------------------------------------------------------------------- ----------•--------------------------------------------- -------------------------------------------------------------- -------- •------------------------------------------------------------------------------------------------------------•-------------------------------------- _______ I 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 andlregulations of the San Joaquin Local Health District. DAY&NIGHT (Signed) tic-Tank-Service------------------- --------------------------- --- � Contractor 1206 So.Eldorado HO 2-70r16 (Title)-- - BY= -----Stockton Calif----- ----- ---w ---------------- l (Plot plan, showing size of lot, location of system in relation wells, buildings +c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- F------------------ ----------------------- --------------------------- ------ DATE----------------------------------•-- -- REVIEWED BY----- ----------- ------- - - ------ DATE----------------------•------------------------------------ -- - - - - - - - - - ----------------------------- BUILDING PERMIT ISSUED------------- ----------------------------- ---------------------=------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------------ =--------- ------------------------------------------------------------------ --------------------•--•-------------------------------- ------------ --------------------------- ------- ----------- --------------- --------- --------- ------ - i '' ----- ---------- ---------------------`-- -- r ------. ...................... ------. Z kr --- _ .........._.. �1! -------------------------------------------- -- e-------- 1 _ FINAL INSPECTION BY: ------------------------------•-----------•---- Date. ------ .a��-j----------------------------------- -------- ' k%s� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATW000 12-54