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FOR OFFICE USE: 3 s _ 6 __ --- APPLICATION FOR SANITATION PERMIT .......Permit No. � .- (Complete in Duplicate) 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 an install the work herein described. This application is made in compliance with County Ordinance No. 5 9 t 6 , JOB ADDRESS AND CAT ON__ ------- - -----�� -... . i ------------------- Owner's Name------- -- --------------------------- Phone-- �a_ ---- Address------------------- a4 / Contractor's Name ` t Phone-_:�._?."_A7?'_ Installation will serve: Residence 9,; partme fiouse ❑ Commercial ❑ Trailer Court Mote! Other ❑ ❑ ❑ Number of living units: ---- Number of bedrooms 1�Number of baths -1--__ Lot size Water Supply: Public systemmmunity system ❑ Private ❑.—Depth to Water Table _ t. I Character of soil fo a depth of 3 feet: Sand [] Gravel ❑ Sandy'Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ®�HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Distance from nearest well-----------------Distance from foundation--------------------Material_...--_-.._.__.__._._._.._--_------.._____--_. No. of compartments--------------------------Size---------------------------- ---Liquid depth------------------------- Capacity----------------------- sal Distance from nearest well .11/..:Dl Stan Ce from foundation---� -__-_--_._..Distance to nearest lot line..... . . ...... Number of lines_ __ ___ Length of each line_-�p--�-------------Width of trench._�_ �I_ Type of filter materiahAep{,r.�i e. Depth of filfier ma erial:___ _ ___ �� Total len th_- _____________ Q-- ------ i Seepage Pit: Dis#ante to nearest well-/_ 6Q lsa ___pistance m foundation-_ P ____._.Distan to nearest lot line------- -------- "� Number of pits__-/---_--_--------Lining material-_- b - --._-.Size: Diameter --------- -.- _ Depth Cesspool: Distance from nearest wail--..____-______Distance from oundation_____.___._--_-....Lining material_____________________________-------. i ❑ Size: Diameter____-- ------------------------------Depth- -----------------------.------------------Li uid Capacity_------------------ �l qgals. Privy: Distance from nearest well-------------------------------------.I--_.=___Distance from nearest building---------- -----._---.-______._---._-.-. ❑ Distance to nearest lot line----------------------------- $------------- ------------------------- I iRemodeling and/or repairing (describe)___________________ ----- -- ------------------------------ - - -------------------------------------- ------ ------------------------- ------ ---- ---- # --------------------------------------------------------------- -------7L------------ ------------------ -------------;--- ----------------- -----------------------------:--------- ------------------------------ -� I hereby certify that 1 h!av, prepared this application and that the-wor'k will be do a in accordance with San Joaquin County_, ordinances, State laws, and 1 and regulations of the Joaquin Local'Health District, 1Jat� CT �iS�t (Signed) ---- ==� .: ,_=� r Contractor SEPTfC--TANK :7ERVICE----------- = - ) 2915 E.Miner Ave. HO.6-3841 By: -----------------------------�------------- ------------------------ - ------ -- ---------- (Title) ------------------------------------- --- ------------------- (Plot plan, showing size of lot, location of sys+em.in rela+ to wells, buildin , etc.;can be placed on reverse side). A FOR DEPARTMENT USE ONLY l � APPLICATION ACCEPTED BY--- ------------------------------------------------------------ DATE-- r - - ------- --------------------- REVIEWEDBY------------------------------------ ------------------------------------------- ------ DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------ --------------------- Alteratio s and/pr reco mendations' -. -r it - --.-- --------- ---------------------------- ----------------------------------- -----------------------------------------------------------=--- -------------------------- --------------------------------------------1---------------------------- ------------------ -------------------------_-------- _-_..._..,— _-------------- ----- FINAL INSPECTION BY:--- - -- ....`�----- Date-----.--LS-b—P 1-�5.----------- .. _ ----- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California a Lodi,California Manteca,California } Tracy,California ` 1 i r.a.co. ' t )