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rUK Urrit,r U,)t: -------•---------- -----��3 ---------------------------------------..--_-_- "' APPLICATION FOR—SANITATION PERMIT Permit No. .`c��s . --------- - ----- ------------------------------ (Complete in Duplicate) --------------- This Permit Expires 1 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 Ordinanc No. 549. 0415 JOB ADDRESS A D LOCATIO �- a_ ___ _ —� f ..t - --- - - --------- --- --- Owner's Name.--- �� -5- *'� L� - - - - -- -- ---- ------ ------- ------------ Phone4bi------------h-------- t Address------------------'��-�--�.�-----��/'C!1.I--- ---- -----�--�-- ----------- --- ------ ---• ---- ---------------...._--------/------------------p--`---/--�- Contractor's Name '- i¢ ---�{—r 1 �f �D' - --/`-< ,� t.---------- Phoney =- fJ.__ `X Installation will serve: Residence ❑ Apartment House ❑ erc' I 7Failer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Water Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe e<ardpan ❑ Previous Application Made: (!f yes,date---------- ---------) No ❑ New Construction: Yes IfURO"NNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -__ yv+ Septic T Distance from nearest well_ Distance from fou anon__. -__ r i _------------------------ - -- -_- _.- No. of compartments__ j-------------------Size- - _--- - _L, uid de th Capacity.-.-- q I? � Disposal field: Distance from nearest well ._ - istance from foundatio _, -"-.--.Distance to nearest I line... 149 Number of lines----_ _---------- --- - --Length of each line--- - - _-�_ Width of trench..-.-- - .- gyp_.----.------- Type of filter materia Depth of filter materia---� -- _ Total length-----7 ------------------_------ Seepage it: Distance to nearest wel _.._.Distancen from f undation----- --- --- Distance to nearest lot line.--/0__. Number of pits___-----------------Lining material_'`-Q. -.-Sze: Di meter_. _4---Depth__�j7�-._.----- Cesspool: Distance from nearest well--._-----.---.--Distance from �undafion .Lining material------------------------------------- n Size: Diameter------------ -----------------------Depth-------- -------------------- - -•----Liquid Capacity--------------- ------------gals. Privy: Distance from nearest well -------------------- _------------.------------Distance from nearest building------------------------------ -. ❑ Distance to nearest lot line ---------------------------------------- --------------- i Remodeling and/or repairing (describe):____- 4---------_-r_. ------------ - ------- ---- --------------------- ----------- --- ---- -- - ------------------------- -- -- - ----------------------- ------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat*.e�laws%d mules and regulations of the an Joaqui Local Health District. (Signed)------------+�'�c__&_--NAt------ ----------------- ------ ------------------------- ----------------- Contractor) SEPTIC TANK S7':MCE Bya91-5€,rM9nw-Av.------#�d.�yel---------------------- - ------(Title)---------------- - ----------------- -- ------- (Plot plan, showing size of lot, location of system in relatio to wells, but in s, etc., can be placed on reverse side) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ e�_. - ------------------------------------------ DATE--- � - -- ------------------ REVIEWEDBY------ -------------------------------------- ------------------------------- ------------------------------------------------ DATE-------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.-.--- ----------------------------------------------------- Alterations and/or recommendations---------------- ------rl--------------------------------------------------------------------------- ----------------------------------------------------- - NIT + ti.Ya. ------ ----------•--------------------- ---------------------------------------------------------------------------------------------------------------------------------------------•-- ------------- -- -------------- --------- e FINAL INSPECTION BY: .- - ---------------------- Date-- . . - - -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C❑.