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FOR OFFICE USE: ---._---._..--.--_.-__________________ _ ---------- APPLICATION FOR SANITATION PERMIT Permit No. _ `5.'� --- -- - ---- ------- (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued trate Issued Application 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 Count Ordinance No. 549, J08 ADDRESS AND LOCATION A ------ 5 ----------•--------------/--��------------------- --------- Owner's Name�A_U,._ tc.{�L t.. # -----x .. � .. - -- .- ------------ Phone44� ----xm_. Address................&.21--c- - --------------------------------------------------- Contractor's Contractor's Name---,- Phone..!a�iC7�-. rYS+� Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Nu ber of bedrooms = Number of baths__ ____ Lot size ___ / �1r_r- / Q -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table t Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 7 Hardpan ❑ Previous Application Made: (If yes,date_-_---___-- l No ❑ New Construction. Yes E] No;M--~FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permi+ted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-KOLL____Dista ce from f99undation__ .........Materiali __ No. of compartnients__�------------------Size ---- !�_s�l��_.Li uid de th ?. it 1 t q ._--- Capacity- �Q__ f Disposal Field: Distance from nearest well-A ____Distance from foundation... -'P __._.Distance to neares lot line---------- Number of lines.1_1_ _ _____ ___ __ Lengfh of each line_____.__��_-P-_ .._.Width of trench.�_r►'�*�____-________._ ` Type of filter materi l *7!t .__...__Depth of filter material___.. -------Total length---- -- --------F_Q__ Seeps a Pit: Distance to nearest 1e1114,0f Le._______Distance from found ation_.-V__ ----, Distance to nearest lot line----- Number of Ir�... ..........Lining material.-gn I -.-- 5ize ts__ p :=Diameter-- ---------Dep#h-.--. -.............. Size: Diameter. .- _ - Distance from. foundation................. ..Lining material-----_-------------------------------- Cesspool: Distance from nearest..swell ------------_-Depth__=-- --------------------------------Liquid Capacity.--------------------------gals. Privy: Distance from nearest well.--....._--_________________..__._- ` ._Distance from nearest building -----------.___.____._________._.__..._. ❑ Distance-to nearest lot line----fi-- ----`---------_----- ------- ----------------= , sem„ . Remodeling and/or repairing (describe7:.__________ ________ �_________ . I .. ------------------------- -- - M1 -- "--- -- -- ------ i i f - :*: _ ---------------- .-------------------------- --- ---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance withySan Joaquin County ordinances, State laws, and and regulations of the San Joaquin Local Health District. t P t- -{Sig(Signed)----------- ned}-----____-- '/' t .-p 01 .. -. { wn and/or Contract - O eror I�`I7C TANK SERVICES # B . JitSly,_Mlnet_Ave.-x- Title:I I By: Sao:e-3saa { 1--------- -- - - --- -- --= "--1- I'll................... (Plot plan, showing size of lot, location of#system in r elan to wells, buildi s, etc., can be �ilaced on'reverSAide). ( FOR DEPARTMENTC0SE;ONLY-w-!P,, APPLICATION ACCEPTED ----- - ----- ------------------------------ ---------- DATE---- . REVIEWED BY------------------ t k- ----------• DATE-- ------------- BUILDING,PERMIT"ISSUED ------------------------------- --- DATE---------------------- - - ------- -------------- - .. ... ,..- - -- Alterations.and/or recommendations:;._._..-____ - - — . -- - 1 ,._. ------------------------------------------------ --------------.-------------------------------------------- ----------------------------- ----"---------- --•- ----- ------------ --------------------- -------- ..--... ..... ................ ----------------------------- i FINAL INSPECTION BY:........` - ------ - - - Date - _C,_7. ----------------------------- SAN - ---------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press