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\"A - f e APPLICATION FOR SANITATION PERMIT Permit No.' ._Q__ r, (Complete in Duplicate) z. f5 Date Issued b/ Applicaa-ion 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 Ordinance No. 549. JOB ADDRESS AND//OCATION____ ------------- Owner's Name - �_ - x Phone �es -- ------------- Address..... ------------Address_---- - -- ----------------------------------------------- Contractor's -------------------------------------- Contractor's Name--- - �:e PhoneXl ., .74-`�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: _/__- Number of bedrooms __Number of baths .-- --- Lot size Water Supply: Public system 2__`6`1mmunity system ❑ Private ❑ Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay am ❑ Clay ❑ Adobe❑ Hardpan ❑ k` Previous Application Made: Yes E] No 2r", New Construction: ,Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Tmnk- Distance from nearest weN-----------------Distance from foundation--------------------Material_______________________--__________..___--_-__. No. of compartments-------------------- ---- Size--------------------------------Liquid depth--------------- ----------Capacity--------------------- ; D sal Ffbld: Distance from nearest well.../-f?.A.-Distance from foundatio ~P _....Distance to nearest lot line_____-►�_______ Number of lines------- _ ___- - Length of each line___ __Lr1_'7-------------Width of trench-�-V29 Type of filter material._____ _ .' . ---Depth _of filter material__-., Total length----10_e_ -------______ -------------- Seepage Pit; Distance to nearest well__ .------Distanc rom f undation____-- __d_ __.Dista ce to nearest lot line___ K+ Number of pits-__/--------------Lining material____ ____ Size: Diameter__-- -��---Depth_.- _�� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- \, ❑ Size: Diameter------------------ ----------_-----Depth----------------------------------------------------Liquid Capacity- ------------------------gals. V Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------. I ❑ Distance to nearest lot line------- - Remodeling and/or repairing (describe)---------------------------------- ----------------•-------------------------------------------- ---------•-------------------• -------------------------------------------------------------------------------------- -------------------------- --------------------------- -------- ------------- --------------------------------------------------------------------------- ---------------•--••-------- ------------------------•-----------------------------------------------------------------------•---------------- I hereby certify that 1-lave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San .Joaquin Local Health District. DAY & NIGHT (Signed)_______ --------------UVicTpnk_Service--------_---- Contract 1. 06 So. Eldorado H02-7046 P,7� ------------------------------ BY: Title------ ----- ----- -------6l�ctart �alaf: ( I (Plot plan, showing size of lot, location of system in relation wells, bucan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ------------------ DATES REVIEWED BY--------------------------- : R ... - ---------------------------- DATE-- : BUILDING PERMIT ISSUED ------�----------------------------------------------------------------------------------. DATE------ -- Alterations and/or recommendations--------------------------- ---------------------------- --- ---------------------------------------------------------- --------------------------------------. -------------- -----------vrcQ�� ------------------------------ ----------------------------------------- ---------- ----------------------------------------- -------------------- act ----------- ------------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BYa 1.- Date t2 f' / �17 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street' 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2)00 f