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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued --- <br /> 15, <br /> A conptruc; apd i all the work herein described. <br /> gplica-�ion is hereby made to the San Joaquin Local Health District fora permit f <br /> �'s application is made in compliance with Coun y <br /> t -0 d'nance No 549 <br /> Ir 1-6-V------------- ------------------------ <br /> JOB ADDRESS AND LOCATION--- -0 <br /> Owner's Name-------- ------- Phone------------------- <br /> 0 r� <br /> Address---------------------1'.1:--- ------- <br /> ------ <br /> ----------------------------------------------------------------------------------------------- <br /> Contractor's Name--------�0�!/ ---------------------------------------------------- <br /> Installation will serve. Residence aV-"Apartment House E] Commercial 0 Trailer Court L] Motel E] Other <br /> Number of living units- I--- Number of bedrooms Number of baths I---- Lot size ------ ---- ---- --- ----------------- <br /> Wafer Supply: Public system (Community system El Private E] Depth to Water Table�� ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam E] Clay [] Adob4[� Hardpan E] <br /> Previous Application Made: Yes E] No [R,`_ New Construction: Yes Z"'No E-] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wellAm 10 Distance from foundation-A2. --------Materiai_c.: �B-7 <br /> Liquid dep�h._%ffW/__.'_#..---------Capacity-g pt,4 <br /> No. of compartments....Z----------------Sizes -- ------ <br /> or <br /> 1-Mn"LL) Distan6ce4fr'orn founclafion�.-/_O O. .......Distance to nearest lot lin --- ---- <br /> Disposal Field: Distance from nearest wel ---------- <br /> Number of lines-------- .........f........Length of each llnei Of t,ench_,"74/'__,. <br /> Type of filter material&*71e-._6k_Depth of filter maherlla _. /tf...... Total length---- --- ----- <br /> Seepage nearest well-N-fAtUO...-------Distance' foundation__- .. .....Distance to nearest lot line__._- --------- <br /> _�t: Distance to ne from ounda i --- ---- - <br /> Number of pits-A_________________Lining material_�=,=_)---- -Size: -------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-..-------..------ Lining material-------------------------------------- <br /> 171 Size: Diameter------ ------ -----------------------Depth--------=------------------- ----_---------------Liquid Capacity- - ------------------------gals. <br /> Privy: Distance from nearest well---------------------------------- -------------Distance from nearest building.____._--___-..---.----____--.-----_---- _� <br /> ❑ <br /> uilding----------------------------------------- <br /> F1Distance to nearest lot line---------------------- --------------- ------------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing [clescribe)- --------- ------------------------------­----------------------I...... - ----------------- <br /> -- ------------- / /, 1-1 - ---------71------*------------------ <br /> ........... / jf�­-------------------------- <br /> ---­-----------­-------­--------I---------------------tsv7;i-11 ­--�;� ---------- <br /> ------- --------------------------------------------------------- --------------------------------------------------I--------------------------------------------------------------------------------------- <br /> ---------------- <br /> -------------------•-----------•----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --- -------------- <br /> Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed DAY &NIQ ........ <br /> pla@----- DAY <br /> I _HT------------------------------ ....... ------- ------------------------- ------.(Qv��-or Contractor) <br /> Se Tank Service -------------(Title)---��ezo---------------- - --------------- <br /> _____12G&-S*;-Eldotada--+10--2-7046-----------------:r -- <br /> (Plot ing size of h*ck*wtjcaad.sysfem-in relation Wells, buildin)fs, etc„ can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- - --- ----------------------------------------------- DATE <br /> - - - <br /> REVIEWED BY--.- -------------------------- ------------ ---* - - - - ----------------------------------� DATEt- ------ ----------- ------a------------------ <br /> -------- <br /> BUILDINGPERMIT ISSUED-------------------------------------V---------------------------------------------------------------- DATE----i_-----------------------------------------­------------- <br /> Alterations and/or recommendations:. ---- <br /> ---------------- -- ---------------------------------------------------------------------------------- <br /> -------------- - - --------------------- ------ ------------------------------------------------- <br /> ---------------------------- - b-------K ----------- <br /> ----------....... -------- --- ------- -- ----- ..... - -------- ... .... --- ------ <br /> ----------- <br /> --------------- -- - - ------- ---- --—-----1Z------ - --- --- - ----- - - <br /> ----- ---- ------------- -A <br /> FINAL INSPECTION BY:.-------- <br /> ----------------- <br /> Date-- <br /> 4— <br /> ----------------------------------------------- <br /> - --- -------------- <br /> - --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWDOD 12.54 <br />