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i4'n vrri4[ VJC: " ----------- -------1�3 ------------------ --------------- ----------- .____ APPLICATION FOR SANITATION PERMIT Permit No. .............. ------------- ------------------------------- ------- (Complete in Duplicate) --- ------ -- -- ___ This Permit Expires i Year From Date Issued 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. JOB ADDRESS AND LOCATION---1kQ3«1405--------(1403-05)._Be_wport;--,gt_oekjtnn------------------------ Owner's Name------------- P 'IhQ1 __ tS ._:r.= ------ - ---- ------- Phone_7�4&62-X0404-+------•---• Address 2612_Z.--Hardjmg--XaY---... ----- - ------------------•-•----•--••------------------------ Contractor's Name-----The__Day.-&--Night.-Septit__�'ams-_S.erviC�----------------------------------------+._. Phone--.466.3841 Installation will serve: Residence [X -Apartment-House'❑—Commer(fial'❑`Trai[er rty[("'Motel`[)—Other []-- Number of living units: ___2'__ Number of bedrooms -----Zr Number of bath s``_-----2'Lot size -----7_,5t-__g____lppx--_-_--__ Water Supply: Public system [Community system E] Private (] Depth�o Water Table ....60ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ (Clay.Loam-E] �Cl16y [--#Adobe Hardpan 0 Previous Application Made: (If yes,date_ _____________) No MX NeZ Construe io Yes Q No❑ FHA/VA*Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: " & -7 (No septic tank or cesspool permitted if public sewer is available within 200-feet.) 1 Septic Tank: Distance from 'nearest well------ Distance from foundation',# 11-______ 1 Material ----------------'------------ . - UC3.sting No. of compartments-- ------------------ ----Size-------------------------�----yLiquid'de th---------- - ---------- Capacity --------------------- Disposal { Disposal Fiefd: Distance from nearest welINO?1�______ _ ) i r Distance from foundation._ .Q __ -._-_.Distance to nearest lot line--- ______...-0 kk Number of lines--------1----------...._.___-_--Len th of each line_____'__ 0! ' �_ Length I Width of trench -�4-- ,------ --- ------•-- W Type of filter material___Segtia__H.kDepth of filter material.......Ign____-___.Total.,l_ength_________________________�t._-----_- I'N ~I Seepage Pit: Distance to nearest well-----None-------Distance from foundation __..-1,f}t__.___.Distance to nearest lot line-__$�___.___._ �C. Number of Pits---.---];---.--------Lining material---xock---------Sizer Diameter'--•-- *---------Deptn-- -- - ---------------- ---- Depth-+---------------------- ... Li u Ca acit a ( Cesspool: Distance from nearest well------------- Distance from founclat'Ort Linin material__ ____________ ❑ Size: Diameter-- -------------- q . .p y -------------g 15 (� Privy: Distance from nearest well__________________________________________ bi to c from nearest buifdtng,'___.._______ ❑ Distance to nearest lot lire--------------- ------------------------------------ __.-._. A Remodeling and/or repairing (describe)______________ __________________________._ X_--- G__E__ ------------------�-------------•------------- ------------------SUPPIEMEN'�ARY-DRA NAG---:---------jjt.�,jg1duglexl_1--hedr-oom-_each.-un « -------------------------------------------------------------------------------------------------- --- ' ------------------------------------------------- ------- -------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- I hereby certify that 1 have prepared this application and that'fhe work will'be done in a�' ccordanc with`San".loac{uiri County ordinances, State laws and rules and regulations of the San Joaquin Local H th District. (Signed)-•---------- ay I- � ------------------- ----------------------- - - --- ----- --- - ---------------------------- -----------(Owner and/or Contractor) 13,+arc--TANK--sE-RVFf:L------------------- ---------------- --�_.- ---------------------- ------------{Title)-------- ---- - ---- -------- ---....- ---------(Plot plaWP;§ N41rii&tf loF(go6l rl of system in relation o lls, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ----- ---= --- --- - -------------------------------------- DATE---------8 �'fr-REV - ---------------- IEWED BY ------------------- ------------------------ ------------------------------------------•--- DATE ------------------------------- BUILDING PERMIT ISSUED.-------------------------------------------------------------—------------------------------------- DATE._.- - -Alterations and/or recommendations:----- --------- ----------- -- --------------------------------------------------------------------------------------------- --------------------------•-------------------------- ---------- ------------------------------------------ ------------------------- -------------------- - --------------•---t' _ ---------- -------- ---------- - -- FINAL INSPECTION BY:---- r/`1 ------------- Date------------ ------- /-- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street �+�` 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F'.P.CO.