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FOR OFFICE USE: ------------ - -- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. _�../.-2 2— ------------- --------------------------- ------------- (Complete in Duplicate) r. Date Issued - -- ---- _-_--- __.____._._,- This Permit Expires 1 Year From 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. 5 �y 1 — 4-001/ JOB ADDRESS AND LOCATION------L-3-1-_. . �_I�/� --d '� p Owner's Name-------------- --------A--K-� ------•------ --------------- - ------ ------------------- -- -------------- Ph � -".-1- -b 7_ Address----------------- , c5�r��3 `�-�-' -----------------------�-------- - �---�-/----------------------- Contractor's Name Y ' �. Phone-.�IL�z C , Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----- Number of bedrooms 3._ Number of baths ---- Lot size ---- //�-__��. ----------------------- Water Supply: Public system F1 Community system ❑ Private Depth t, Water Table /09 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date.................... No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1. (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) tic tT kt, Distance from nearest well________________Distance from foundation---______________..Material______-.____._..____.._______________.________�Fp . ■� /'/�(r�� N(5 of compartments--------------------------Size-----••-------------------------Liquid epth-------------------------Capacity----------------------- Y 0 4 l Distance from nearest well-4_®_ _.Distance from foundation____ ____.__-f-_.Distance to nearest lot line____-_��_r 1 Number of lines------- -- ----------- -- - -Length of each line-----�t ------------.Width of trench._ ��-.--- -----�-- j r Type of filter material_ Depth of filter matenal____ 471-----Total length_____________________.-_ ------- i �� Pit: Distance to nearest well/�P ._. Distance-from___ f undation______.Q---- an ftp nearest lot line____ _.. Seepage Number of pits---- -----------:-----Lining material--- � _--..Size. Diameter----�-�-----Depth_.-, ----------------- Cesspool: Distance from nearest well-----------------Distance fro oundation----------------....Lining material------------------------------------- p AA. ❑ Size: Diameter:------ ---------- ---------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------------------- ... ❑ Distance to nearest lot rine- --------- ------------------ -------------------------•---------------------------------•----------- --------------------- Remodeling and/or repairing (describe):----- --------------- --•----- ------------------ ---- ---------- �_tC�t-� nom.. ------------------------------------------------ ------------------------------------ ----- ---------------------------------------------------------------•---------------------------------------------------------------------------------- ----------------- I hereby cer+ify.that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District. f ' �• - - -.-------- or Contractor) SEPTIC TANK SERVICE Bye- 9F :fv�Fner we:; t FE':fs�384i-------------jrelaf�ion --------Title).-.----------------- --------- --- - -------------- (Plot plan, showing size of lot, location of systemwells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE-- _' /�' -•----------------------------- IREVIEWED BY------------------------- -------------------------------- -------------- --------------------- --------------=-------------- DATE-----------------------------------------_---------------- BUILDING ------------- --------- BUILDING PERMIT ISSUED--------------------------- - .DATE___ ...____._ Alterations and/or recommendations' %^ ' �� ' fi :' � ,•------------------------------------------•-----------•-------------------------------- ....------------------------ ----------------------------- ---------------------- ------ 0 .�- . �------------- --- FINAL INSPECTION BY:------ - - --- - - -- ----- Date- -------- -------- -- -- --- -- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. 16