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of Ito f Permit No. . APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued _" --- ----• Applica{ion is hereby made #o the San Joaquin Local Health District for a permit to construct and install the work herein described.. 9. This application is made in compliance with County Ordin&nr, O. 54 S/ --—--------- JOB ADDRESS AN LOCATION._____ phoney---------' ------------------- Owner s Name---- ? -- _ =- Address..- - `T - r.-� `'* h.. ------------------------- Phone Contractors Name_____________ `�" `~ frailer Court❑ Motel ❑ Other ❑ �} House ❑ Commercial ❑ �`- lnstallation will serve: Residence �partm SFU � Number of baths I--- Lot size ------------------------------------ Number of living units: ---- Number of bedrooms __ �." Water Supply: Public system 6 C—ommunity system ❑ Private ❑ Depth to Water Table -Cla f t' Adobe[�Nardpan C]Grave ❑l Sandy Loam F-1ClayLoam ❑: y ❑ Character of soil to a depth of 3 feet: Sand ❑ !1i Previous Application Made: Yes [3 No &--New Construction: Yes ��o El TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200Q �r�� - Distance from ou ation__ ___ ___________. Meteraal'' --- ------- Septic Tank: Distance from near esr well__ . / 3 fr Ca aci# . No. of compartments_--- - F Size_ fP3er Liquid depth--. -._ P Y, -' - ---------- - �` '� `�f___.Distance-to nearest lot lin Disposal Field: Distance from nearjst well =--Mstan e from ou a}ion_ __- Width of trench._-.[ - --y-------------- � r Number of lines__ .1-"-- --- =�' 'Length of each line__- - (!d' / Total length----"--• ----- ---- ---------- Type of filter materia ZIP _ tL= Depth of filter mater al-__.."L�=--- Seepage Pi{; Distance to nearest well-.r Oxy j�--Distant rom oundation__________________D�st�nce to nearest lot i . .,, � ----- Size: Diameter----�`-��-- -------Deptn...�>�-----------•--.__._.. Number of pits------ -------- Lining material-- -----"----- - nearest well-__._-____-'.---Distance from foundation--------------------Lining material_____..---"------ gals. �1 Cesspool: Distance from n Li uid Capacity....__--------------------- ❑ Size: Diameter----------------- ----------------- -------------"---Depth------------------ q 1? Distance from nearest building------------------------------------------ Privy: Distance from rearest well..--------- ----,--------------------- ❑ Distance#o nearest lot ine.-__---------- •----------------------•--- I Remodeling and/or repair}ng (describe)----------------------------------------------- ------------------------------------------------ -------------------------------------------------------- ----- ----------------------------- -------------------•------------ ------•------•----------•----------------------- ---•----------- -----------------------------------------•------ ---------•---------------•---------------------- ----------- ! here- -by- --certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ----- -- - ----- ordinances, S aws, and rub 's of the San Jo q in Locate Healt District. $gptic Tank Service i /" - ------ ------ ---- - --(Ow�1eftr.Contractor) --- - ----- ------ (Signed)------- ----1206-Sw.ftdorr€d ---HO"2=70�ib" ------- - ,I 1/ / By:---•-------=--------------•----- 5tac Cton�_Calif, ... ------. Jr � - ------ -- ---- -------- (Piot plan, showing-size of lot, location of system in relation ells, buildings, et , can be placed on reverse side). FOR DE TMENT USE ONLY DATE-------- --�5 ------- - --- APPLICATION ACCEPTED [3 --------------------- ------ DATE------------------------ ---- ------ REVIEWEDBY----------------- ----- ------------- ------ - "-. DA ----- BUILDINGPERMIT ISSUED------------------------------------------------- -------••----- •----------------------------•---------------•--- Alterations and/or recommendations:--..__--- -_-- _____. ----------------------------------------- e ------------------•------------------- -•-- -------------------- - E1----------- Date FINAL INSPECTION -�-- - --------------------------- - .- .�.---- ---=--- - '-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California Er;_g,2M 145446 ATWOOO 12-sa ..