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itr-UKVJ-V-K&!�1:15t:-------- ----------------- ---------------- ------ ------- --------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------------------------- - -------------- (Complete in Duplicate) ...... ---------------------------- ........ This Permit Ex ires I Year From Date Issued-a Date Issued Application is hereby made to the San Joaquin Local Health District for a permit T40.1co-ristruct and-install't'l-re work herein described. :This application is made in com lian'c r' ith County Ordinance No. S49. P? 36,0 3Z JOB 2— JOB ADDRESS AND L V13 ----- ---- ------T4, ------ -- -------- _ � ' �- Owner's Name - --------- ------ ---------------------- -------- Phone_;. Address------------------------- - ------------- ------------ ........ 12!vlp------------------- 11•---------------------------------------------------- Contractor's Name---- -------- ------------ ez , Phone..- Installation will serve: Residence ®!Apartment House ❑ Commercial El Trailer Court ❑ Motel [I Other El Number of living units: ------ Number of bedrooms� umber of baths !-�- of size I ---------- ..... Wafer Supply: Public system ElCommunity system i--flivate Ej Depth to Water Tableft. Character of soil to a depth of 3 fee I f: Sand E] Gravel E] Sandy Loam E9,0"C'lay Loam I-] iClay ❑ Adobe Ef Hardpan 0 :Previous Application Made: (if yes,date-------------------._) No El New Construction: Yes VIN':o ❑ FHA/VA: Yes E] No 0. YPE:OF'INSTALLATION ANDSPECIFICATIONS:-4' (No septic tank or cesspool permitted if pu6l' s is available within 200 feet.) Sepfic,Xnk: nearest ----- ----------------- Distance from ne t well- _._----Distance from fo -n—dafirn--- ----------- eo No, of compartments----Z------------------Size.3.'-/,--91.1*4-tk! iqu,id�,,K -214---------------- Capacity-Foa Pisposal r-'eld.- Distance from nearest well. .-Distance from-foundation ance jo nearesttlotjine------- Number of fines- Length 0-fleach IiZe*- 1141J"-'-74?-'7Widfh of Trench.. -- ---- Type of filter ma ...... —I L s. -Depth of filter material_ _ _-P71111 ....Total length------------- ----- - ----- 'Seepage Pit: Distance to nearest well -------Distance from foundation---------_-_---._.Distance to nearest lot line_-- ---------Ft ❑ Number of pits___'---'------------- ---Lining material-----------------------Size: Diameter------------ -I- ..........Depth-------------------------- ------ :.Cesspool: Distance from nearest well-- --------------Distance from foundation--------------------Lining material-- ---------------------------------- 0 Size: Diameter-----1----- ------------------ ----Depth-------------------------------------- -------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest I rest wel�-------------- ----------------------_--...._._Distance from nearest building___.-..___-------------__---_____------_ ------- ❑ Distance to nearest lot line.-, -------------------------------------------- :Remodeling and/or repairing (descril -- ---------------------------------------------------------------------------------------- -----------------------------------------------------•-----------------•----------------------------- - --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ----------------------------------------------------------- -t--------------------------------------------------------------------------------------- .74 -- ---------------------------------------------------------------- 11----------------------------------------------------------------------------------------------------------------------------------------------------------------��--,------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, So. laws, and rub,%jnjjNq diftris of the San Joaquin Local Health District. Sepliz Tank Service" (Signed)------ ---------------------------------- ------------ ----- Contractor) tE? By:---- -----------------------St tp ------------- !�Z7 lif. Z ' n system in P (Plot plan, showing size of lot, locatio.' of s rel�afion � wells, {Title)lbulireverse -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By-----1-'1R,--10---, ------- DATE-------- ------------------- --------------------------------------- - —---------- REVIEWED BY------ ------------------------- ------- ---- --------------------------- ----------- ------- -------------------------------* DATE--. - BUILDING PERMIT ISSUED------------------------------------------------------ ----------------------------------------------. DATE Alterations and/or recommendations:_- _-__-._ -------------------------------------- ------------------------ ----- ----------- --------------------------------------------------------------------------------------------------------------------------------------- ------------ --------------I-------------- --------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------- - - -- ---------------------- -------------------- ------------------------ - ------------ - ----------------------- --------- -- --------------- --- - ---------- ----------------------------- - --------------- ------------------ ----- f ---- ------ RNAL INSPECTIO Y.. --- -- ------ - ------ - ------ ------------ Date- --------- ----- Jo.... SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th'street Stockton,California Lodi,California Manteca,Cojifornia Tracy,California F.P.Co.