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FORT OFFFICEIr USE: 7. _` ________________ APPLICATRD=N FOR SANITATION PERMIT Permit No. .�. (Complete in Duplicate) ------------ -- I 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 in li the work herein described. + This application is made in compliance with County Ordinance 49. JOB ADDRESS ANQ ATION_______ ------ Owner's Name.-- -�-------••-•------ - -- --------- •-- --- - ----- ------------ "---------- - Phone----------- f � Address--------------- `� Contractor's Na - •' �- .c - g -------...... Phone----------------------------------- Installation will serve: Residence Apartment Hou Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: V N ber of bedrooms..,.._ Number of baths --*?"/Lot size .___- Water Supply: Public system Community system E] Private E] Depth to Water Table ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe ardpan ❑ Previous Application Made: IIf yes,date------__-----___----_I -No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ t { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic rTa1 Distance from nearest well_________________Distance from foundation----------------._Material---_------------------ ------------------------- t No. of comparttmments:-:n�--- R--------Size-------------------------------Liquid depth---------------'--------_ Capacity---------------------- ,e� __._ is os q Distance from Weare t well . . _.__Distance from fou4ndation.__ _.__Distance to nearest lot line_._ / Number of lines_____ _ ' Length of each line 9 �3 Width of trench-a . a �� ------ .. Type of;filter materiaiet1_ __Depth of filter material----.__ __Total length---------------- r - � p 9 Seepa e Pit: Distance to nearest well -_ Distance rIM , undation__ Distance to nearest lot line--,,/-J �! 1 _ Number of ts._ � L- size: Diameter_ -�- - :- �� r P �. - . Lining'material- - r } .. . P � !------ De th_ -- ---Aj Cesspool: Distance from nearest well_________________Distance frundation...__.______._-__,__Lining material------------------------------------- { ❑ -------------______.__Liquid Capacity O Size: Diameter--------- -------------- Depth-------- - --------------------'- q P Y---------- - -----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line___ ` Remodeling and/or repairing (describe----- -- --- ------- --- ---------------------------------- ------ -------------=--------------------- ------------------ ---------------------------------------------------------------------------- ------- ----- ------------------ --------- ---------- --------------------------- t ... _ r 1 -------- ------------------ -------------------- ----------------------- ---------------- -------------------------•------------------------------------------------------------------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, mules and regulations of the San Joaquin Local Health District. 1 (Signed)------ elJay /Ji��a Contractor) ---- -- ------- - ----------------------- SEPTIC TANK SERVACE ; By:-- � .t~.�1di>�er.Aue_,t ' kLQ,fv3t L-------------- ---------------------- - --------- ---------(Title)-------------------------------------- --- ----- (Plot plan, showing size of lot, location of system in relation tow IIs, buildings, a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------------------------------------------- -�— DATE !--------------- REVIEWEDBY------------------------------------- -- --------------------------------------------------------------------------------- DATE--- ------ - t / BUILDING PERMIT ISSUED------------- -- DATES- -- Alterations and/or recommendations __.__.- _ _. �'_. .----------^ --t_-------- y_�- - -t�� ------------ -- =-----J---S=------- r-4-�—.�----- - --------------------------- ---------------------------I------------------------------- -------- ------------------------------ -------- ---- ----------------------------------------- ------- ------------------------------------------------------ FINAL INSPECTION BY-------------- -------- ------ -------------- Date----- ' --------- ---- --------- SANOUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 est Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.Ca.