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rk APPLICATION FOR SANITATION PERMIT Permit No. ... (Complefe-in Duplicate) J k ' Date issued _�?•- l 7 '0' 10,• o�.._. Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install t� rk herein described. _This application is made in comp€• nce with County Ordinance No. 549. —JOB-ADDRESS AND LOCATION.. ---------- ----___f`(- ___s ` .•_-• _ ._ - lY`�"`" l,� �--•-- --- Owner's Phone... Address----------------- _=� ------------•--•---------------- ----------•--------------------------------------------- Contractor's Name.- ' --- '� ---- -----------5�7 ...... �--------------------------------- --- Phone�g Installation will serve: Residence [. JJ A artent House Commercial L�' p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms_._ Number of baths _/._ Lot size -••------------------------ Ll Water Supply. Public system ❑ Community system ❑ Private [j--15epth to Water Table -------- ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Tay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes [❑ No Rt -`New Construction: Yes [tea-'❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , .1 (No septic tank or cesspool permitted if public�!qwer is available within 200 feet.) l p '`- Septic Tank:-w— Distance from.nearest well ---7�'D.istance from fo „dation- � '-----Material---- [ � No, of compartments m-�---- Size_-_ _,�' ____�Li uid de th--- -_._. ._ .. Ca aci7y..�q p --- p ------- rr r Disposal Field: Distance from nearest well.ST-'----Distanc from foundation_ , `.._.Distance to nearest lot line.—__-__. 4 Number of lines______._._ ..__ Length of each line___�_ __rp--.-_-------------Width of trench__+Z__�_/--______________ '# Type of filter materia ._.__ _. . _[LI Depth of filter material----�p.-�- _-.Total length------/X-v-- ------------------Seepage Pit: Distance to nearest well------------------_---Distance from foundation------------.-._._..Distance to nearest lot line__.-_----_____.._ ❑ Number of pits----------------------Lining material----------.------------Size. Diameter----------- ------Depth--------------------------------- Cesspool: Distance from nearest wel ----------------- from foundation--------------------Lining material------------------------------------- Size: Diameter--------------------- - - --'----Deth....---.......... ❑ x Depth_ -•--•----------'------ -'- -' - --Liquid Capacity-----------------------------gals. , Privy: Distance from nearest well____________________________________.____.._Distance from nearest building--__...._____________-.-__-_-____.___.___. ❑ Distance to nearest lot line------------------------------------ ---- ----------------------••-------------- ------------------------------------------------------------- Remodeling and/or repairing (describe):------ ----------------------------------------------------------------------••---------------- -------•--------------•------------------------•---•-- ' ------------------------- -•------- E ------------------------_----------------------------------------------------------------------_--------------------------------------------------------_--------------_------------------------------------------------------ I hereby cerfify 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. (Signed) 1�95DAY& NIGHT ie Tank Service 7 Contracfor) i 206 So. Eldorado -A x404 /buildings, --" lot. plan-,_,showin rsi:e of-lot, location ofisysttem in relation to well etc., cant be€e)laced o-'w(P P 9Y _ _.. A _. . averse side),� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------'---------- - -- - ---- --- ----'-'--'- '- --- ---•---- - -- DATE---------- VREVIEWED i3Y ---------------------------'---- ----- -, '- "'----- -------- ------ DATE-------=�-- --------------------- BUILDING PERMIT ISSUED------------------------------ ---------- --------------- -•--------------------------- ------------ DATE Alterations and/or recommendations---------------------------------------- - -------------------------------•--------------------------------------------•- -- ------------- ------•------------------------------------------ - ----------------------•----------------- --- ---- --- -- •--- ------------------•----------------------------------------•---------------------------•---------------•----------------------- FINAL INSPECTION BY:-------------WI -------------------------•------ Date----'-'--- ' `v ' 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 �S-9' 345446 ATWOOO '