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U1,ry APPLICATION FOR SANITATION PERMIT Permit No. ..._...__ (Complete in Duplicate) 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 Ordin e No. 549. E. ------------------------ z -------- JOB ADDRESS AND LOCATION--:--- ---- - ------------------ - -- ;--- Phone �------------- ------- Address --------- - ----------- --------- - ----- ---- - Phone----••_----•--------•--------------- Owner s Name-- 1 -` ` = ----------- ------- Address -`---- � - -------- .. G1 r ' ---- ----------- Phon ----- -•--------- Contractor's Name----------------------•- - -- Installation will serve: Residence partment House ❑ Commercial ❑ T eller Court ❑ Motel Other ❑ Number of living units: __..l__ Number of bedrooms __.Number of baths _�____ Lot size _ - Water Supply: Public system C ommuriity system ❑ Private ❑ Depth to Water Table it. Character of soil to a depth of 3 #eet: Sand E] Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe � Hardpan ID Previous Application Made: Yes ❑ No 9i---N_'ew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or`cesspool permitted if public sewer is available within 200 feet.] Se ., Tart�C Distance from nearest well_________________Distance from foundation--------------------Material-___._______---__________--__________._.--.___. No. of compartments-------------- Size------- --------------------- Liquid depth Capacity .� Disposal R Id: Distance from nearest well- ______________.Distance from foundation__ � _____.-.Distance to nearest lot lin'_________________ " .Number of lines-__:_ - -- ----------- --- Length -of each line__-- -------- -._.Width of trench--- ------------------ Type of filter material '4R4f__.Depth of filter material__ZS ------Total. length______�a----------------- u yd - /� Distance to nearest lot line__._.-_______ ----- Seepage it:'1P -Number Distance to nearest well__ ' ----Distance,from foundation__„ Depth_.._..- �•--------- ES Number of pits____________ _____Lining material- ------ Size: Diameter____ -- Cesspool: Distance from.#nearest well_______--_____Distance from foundation___._--- _._____- Lining material__ ________________________.___.____-. --Liquid Capacity gals. El Size: Diameter" --------- ---�----- . --------- Depth ---------- ----------------- ---- ------ Privy: Distance from nearest weft-------------------------------------------- --Distance from nearest building------------------------------------------ ---= =- Distance to nearest' of ine_ ------------------------------------------------- l Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------El -- ------ ------------------------------------------------------------------------------------- -------------------------•------------------------------ t --- --- - -- - --- - --- - 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 and regulations of the San Joaquin Local Health District. D"&NIGHT (Signed] ► Septic Tank Service-- -------- ---- --- - ---- - --- ---- ----------------- -----(fir-anc# car Contractor] ----- Ydi?$50.Eldorado H-0 2-7046 By:-------- -.------------------ SfoclEtcsrr--fvcrgf = ----- -------------(Title] (Plot plan, showing size of lot, location of system in relation wells, building etc., tan be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICAT€ON ACCEPTED BY ---------- ------- - DATE---- ----- ATE ---- - ----------------- DATE. ,ems REVIEWED BY-----------------------------=-- --------------------- --- --- -----------. DATE--- . -- ------- ---------------------------- BUILDING PERMIT ISSUED------'-=----------------------- ---- ---- ------------------------------------ Alterations and/or recommendations:__--___-______ _ __ ___________-_._____._-_ - ---•---- r ------•-------•------•-------•---- ------------------------ ---------------••------- ------••--------------------------- ------------- t�3 -�� -i ---�.��------------------------- --------- --------- ----- ------- ----------------- � ------ ---------- -- -i FINAL INSPECTION BY:._--I -- — ---------------- " Date-- Y 2, .J-------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTR CT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street � Trac Stockton, California Lodi, California Manteca, California y, California ES-9-2M Reviseci 1.57 F.P.CO.