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FOR OFFICE USE: .......... . ... I „ •----.--.-..- APPLICATION FOR SANITATION PERMIT Permit No. .r�-. .. .....................•---•--.............---.......... (Complete in Duplicate) Date Issued _.7.:-.�.�....� This Permit Expires I Year From Date Issued . Application is hereby made to the San Joaquin Local Health District for a er it to nstr tan irista II 00w- Brei ribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A _......... �,9�1z�Jrp............................... ... Owner's Name .COQ-•��r --....................................... .. .. ............-- ......... Phone. Address--O'ry"w, ---------�....- .................. .. ............................................................ Contractor's Namre.-11 .. {i� /� fir........... ... .. Phone.,�j�Gb"• �3..T..f Installation will serve: Residence Apartment House ,., Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: --I----- Number of bedrooms .../�Num��D�epth fs .- 4. Lot size Water Supply: Publics stem Community system Private to Water Table .._..... ft.PP Y� Y ❑ Y Y ❑ _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ I Previous Application Made: (If yes,date. ) No ❑ New Construction: Yes ❑ Ns FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: EtE (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 ,Q �( L • /� Maternal Sepfiic Tank: Distance from nearest w Il..t-OQ_- D�st'�nf� fro y fo tion.._.1............. No. of compartments_ e�>� . Liquid de th . �f ._..._- .- . S. . _.. P. t ----.........Capacity-4Z.QQ D• s field: Distance from nearest wel:.................Distance from foundation....................Distance to nearest lot line................. Number of lines--- ------------------------------Length o: each line..............................Width of trend.......................------------ Type of filter material-. . .... .._.Depth of filter material........ I ..notal length---..............c_................... ... Seepage Pit: D70ance io neares`. well... ............ . Distance from foundation....................Distance to nearest lot line................. 1 U Number of pits----------------------Lining material----...... I Size: Diameter.......................Dep`h_--._.............._.__......... Cesspool: Dist-rice from nearest well-----------------Distance from foundation................... Lining material. .............................. ❑ Size: Diameter----.-...................... Depih.......................................... . Liquid Capacity q P Y..................•--- ....gals. Privy: Distance from nearest well.................. . .........................Distance from nearest building ......-........._............_ .. ❑ Distance to nearest lot ;ire..............................................................•-----•-----•-.................................. ...._....._. . ........ Remodeling and/or repairing (describe):......... \ _ ......................................................... ......... ....... .............: ............. ......... --._.._...•-- J ----- -----•---•------••-----------•--------------------------- -------------------------•-•-------. -----------------_...........--..................................--....... .......... ............... I hereby certify that I have preparod this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District. e � (Signeda f!i �v ...... -.... (Owner and/or Contractor) SE=PTIC TANK SERVICE. - By= 2+31vE:fr}irtt�rfive:;- rh:x 3841------ - - -------------------- -.....(Title).... - . . ----- (Plot ---(Plot plan, showing size of lot, location of system in relation t wells, buil Ings)etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... . - - ------------ •- ................. DATE------ -- ------- --- --...-7-------.........----------- REVIEWED BY------ ------------- ----------- •---- . . . ------------ ---- --- - ---- ........---- DATE............................................................ -••----................_.........._.........._....--- --- ._ BUILDING PERMIT ISSUED.............................................--------.-.-----_......_.....-----•---•--............. - ...... DATE............................................................. Alterationsand/or recommendations:............................................ --------------------------------------------------------------------------------------------...........---•--- .......................•-•._.._.._.. .......................................................... -- . ..................................... . . ........ ... ........................................... --•-•........................•_........................................---_.._........-......._....... --------------...................-------•--------------.............................. .............................. ...................•...........................--•--•----........._............. ----•-------....... ---.........------..._.........-----•....-•-------.....------ ••------...._...................._..._..............-- i ........................... . . .. I . .. .................................................... .............................................................................. ................................... FINAL INSPECTION BY:. /`. r6�_�.t! '!/_ =!ae�l/t. Date.--- 3..�....{? .......................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazatlan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. I