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' APPLICATiON FOR SANITATION PERMIT Permit No. .- -$1_ .__ w (Complete in Duplicate) b Date Issued 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. JOB ADDRESS AND / LOCATION--------- �---iN-= �- -��- .1 .�f�.__ , ll�-r�--�� - ------------------------ Owner's Name--------rV6Pf1------7Y_17_ 0*j'17 ----------- Phone_ 7 -01S----------------------------------------- ------ -------------------------- Address-----------------------1 316-. -zt � - ----- S1,.---------------------------------------------------------------------------- ---------------•-----•---------------- Contractor's Name--------------------------------------------------- ----------------------------------------------------------------------------------------- Phone--------------------- ---------- Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ 1 Number of living units: _l.__--- mber of bedrooms _f___ Number of baths I... Lot size __ZQ�----- _.-------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam ❑ Clay ❑ Adobe W-1/Hardpan ❑ Previous Application Made: Yes ER No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Distance from nearest well_________________Distance from foundation--------------------Material------__----_-__----_______________________.____. o. of compartments--------------------------Size--------------------------------Liquid depth-------- ------CapacitY----------------------- D' sa eld Distance from nearest well.................Distance from foundation__________________Distance to nearest lot line____________-____ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------_--------- Yp P ` slier t erial.-------------- -------Tota length--------------- ------------- ----------•- Seepage Pit: Distance to nearest weEl____# c __ is'tanc omjfoundafio _ ._.___.Dist r #o Weare Loftline__`________..- e of iter materia__________ ______ 04S trl Number of ts.__. __Linin aterial__ ameter_____ r__.De t' __� P g p Cesspool: Distance from nearest well-_____________ __Distance from .________.______.Lining material_______________-_._ -________-_1Size: Diameter-------------------------- ----------- e th------------- --------------Liquid Capacity_------------------------ga s� rr Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.-_----_-------------- ❑ Distance to nearest lot line------------------------------------------------------------------------------ ---------------- ------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------- ....... -------------•------------------------•------------------------------------------------- --------------------------------------------------------------------- -----------------------------•--------•------------------------ --------------------------------------------------------------------------------------- -------------------•--•----------------------------------------------------------------------------- ----------------------------- -----------------------------------------------------•-----------------------•--------------------------------------------------------------'----------------------------------------------------------------- -------------- 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 DAY cleft ons HTof the San Joaquin Local Health District. Septic Tank 5_ervice-- _-------- -- --- �,------ Contractor (Signed)---- 11 b So.Eldorado HO 2.7OA6 BY: — _ 5t©cktor�,-�' ii€, -(Title) ') (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ------------------------------------------------------------------- DATE-----�__)------------------------------------------------- REVIEWED BY--------------------------------------------- DATE---------- ----- - -------------------- ------------ BUILDING PERMIT ISSUED-------------------------- ------- ------------------------------------------------------------ DATE----------------- --- -----..Alterations and/or re mmendations: ----- ---- ----- ---------- ------------------------------------------------•------------ -=-------------------------------•--- - ----------- -- �'' ` ------- ------------ --------------------------------------------------------------------------------------------------------------------- ". --------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------y-------------------------- -------------------------------- FINAL INSPECTION BY:---- / ------------------------------------- Date... 1. - -_-_-._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lode, California Manteca, California Tracy, California `A,,--2M Revised W-2100