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FOR OFFICE USE: ,I - APPLICATION FOR SANITATION PERMIl�„ :� Permit No. �' - - - -------------- ------------------ ---------------- {Complete in Duplicate) S Date Issued ______________ ----------- This Permit Expires 1_Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance nor Ordinance N 549. r JOB ADDRESS AND LOCATION-- �� l 621 ------------ Owner's Name FFA ------- �°� h.Q�Sr'.�'------•----------- Phone Address-----------------------/ / ..-. -- '<f _ '---AAY-------------------------------------------•--------------------- Contractor's Name -.l__-0---- - _ Phone-------- :-----.. Installation will serve: Residencey partment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ..?__ Nu r of bedrooms __ -____ Number of baths_ Lot size �Q- --- Number of living units: __ \ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TaHe -------- ft. I Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam.❑ Clay Loam El Clay E] Adobe ardpan❑ Previous Application Made: (If yes,date__/_ No E] New Construction: Yes E] No --FHA/VA: Yes E] No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: ,� \ (No septic tank or cesspool permitted if public sewer is available within 200,feet.) N ti Distance from nearest well_________________Distance from foundation__._._____---------Material-------------------------..___-____--- _______. 1 - r.:. a vlJl No. of compartments---------- ---------------Size::--��------------- --=---Liquid dem----------------- --------Capacity--•----------=------ � el Distance from nearest well-t_CVW_Distance from foundation__/_�._ --.Distance to nearest lot line______-_ Number of lines________ _ ___________ _ ____Length of each"line:_ ` " 0!� '' Or -fid Width of trench_._ cl Type of filter mate[ Depth of filterl\mater• --Z_ __ , Total length__________________ - I it: Distance to nearest well_ _ R_I Distance from �n.l','afion_______�_�-_. Di ance to nearest lot ine- -----Linin materiaize: Diameter-._-�, �f-----Depth--r �---- ---Number of pits_.__.___-__- g ��""--_��CesspDistance from nearest well_-_-------------Distance from founation----__-----__--_-lining material__----------_______---__--P__-___-_ ❑ Size: Diameter--------- ----- ---- -----------Depth------------------------------- --------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well--'v_-------------___--------------------------------------:_-Distance from nearest building----_---____--_________-_-_ J1':v I ❑ _ , Distance to nearest lot line .- -- ---------- ---------=------ ---------------- ----------------------------- -- ----------------------------------- Remodeling and/or repairing (describe}:_- f-I - ' - ------------- ----- --- ----- 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, "l rules and regulations o4 f t Joaquin Local Health District. (Signed) ------------ ------------------ r Contractor) SEPTIC TANK SERVICE -----------------(Title) x5 1 :IVIT er Av--------— 4I [Plot plan, sawing sze olzlot,4oe9f11% bf system in rel onto wells, build' gs, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ( -P..------------------------------------------------- DATE----- - REVIEWEDBY------------------------------- ----------------------------------------------- ----------- -------------- --- DATE-- •--------------------------------------- --------------- BUILDINGPERMIT ISSUED-------- ---------------------------------------------------------------------------------- --------- DATE----------- ------------------------------------------------ Alterationsand/or recommendations-------- -------------------- --------------------------------------------------------------------•-----------------------------------------•------- ---------------------------------- ------ ---- ------------------------ ---------------------------------------------- -------------------------------------------------- ----------------------------------- --------------------- ----------------------- ----- - - ---------=--- --- ------------ ---------- ----------- ----------- ---------------------- ---------------------- --------------------- ----------------------- FINAL INSPECTION BY:- G�� ✓� ----------- Dated 9 ,��` OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Atl!r/ [r 30 W T Oak Street 124 Sycamore Street 405 West 9th Street Sloeklon,California Lodi,California Manteca,California Tracy,California F.RCO�