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FOR OFFICE USE: ------------- �-b 14-v- ----------- _r r .Rlc7 -__ APPLICATION FOR SANITATION PERMIT Permit No. _1. ----- z7- - -- --------------------//------- (Complete in Duplicate) S - --- ------------------------"-------------I--------.--- This Permit Expires ] 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, pp p y Ordinance No. 54 This application is made m com liance rrh Count Ordinan .� JOB ADDRESS AND LOCATIO --- T- -------------- Owner's Name------- _t-lX--_. ------------------- Address --------------------- ---- Phone _ -_ Address---------------------- - --------- - -------------------------- -- -- ------- Contractor's Nam - --------- --�-- �� " '' Phone.- !� Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trail r Court ❑ Motel ❑ Other ❑ Number of living units: _(-_--- Number of bedrooms__ Number of baths _ _ Lot size ____ ___.-10``.-:----------- -- ------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. r JI Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan 11a. Previous Application Made: (If yes,date_---------.........1 No ElNew Construction: Yes ElNo FHA/VA: Yes ❑ No g TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Distance from nearest well-----------------Distance from foundation-----------------_Material---------- of compartments--------------------- ---Size--------------------------------Liquid depth "ap .ci Y. spoil e d• Disfance from near st well--- -_Distance from foundation----1�.-.Distance to h�rreest4ilo line.l.-- ---� Number of lines---- ____________ _ Length of each lme �------- Width of trench_ -_-.____.._....__.._.. �. Type of filter material_ ___Depth of filter materiaL__.____lTo#al length____ j S a it Distance to nearest well--Y- )-.g ___Distance fr - foundation-_I�l____-_.-.Distance to nearest lot line-_ Size: Diameter_.=. # Dept /____________.___ Number of pits--- -•�------- Linmaterial--------------- ��- p �-�-- Cesspool: Distance from nearest well-----------------Distance from oundation-----.--------------Lining material--.-____._-_--- --__-..--__--_.- ❑ Size: Diameter------------------------------------- Depth----------- --- --------------- - -----------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------__----.-----_.-Distance from nearest building-----------------------------------.-----. I ❑ Distance to nearest lot line----------------- -- ------------------------------------------------------------------------------ = �• Remodeling and/or repairing (describe}---------- ------ ----------------- --------------------, --- ----------------------------------- i -- ---- --- ----------- --- - - ----------------------------- ------ -- -- ------- ------- ---------------------------------------------- - - - --------- -------------- --------------------------------------------- -- ---------- -- I here- -by 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 reg ons of the San Joaquin Local Health District. (Signed) --------- ---- ---- By: - or Contractor} k� OPTIC TANK -BERVICI ------------ -- -------2915.E-Miner � (Title) BY�----------------- ---- Ave:---;-Ff 6-------i - --- - (Plot plan, showing size of lot, location of sysiem K relation to wells, i ings, etc. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-------.- ------------------------------------- DATE--- -r ----------- REVIEWEDBY------ ----------------------- -- ---------------------- - - DATE---- - ----------------------- ------------------------ BUILDINGPERMIT ISSUED------------- ---------- ------ ---------------------------�----- � DATE------------------ --------_------------ ---- `------------a Alterations and/or recommendations:............ ------- � -------------------------- - --------- ------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------- ------------------- ---------------------- ---------------------------------- --------------------- --------------------------------------------------------------------- FINAL INSPECTION BY:- .... ----�~--------- Date.... ........ _/- -------+.'- - -------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1841 E.Hazelton Ave. 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California F.P.CO.