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I �J ��K rictu�0 �i -------- -------------- -- --------------------- ------------ --------- 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-p ._- -- -- - -- ----- ' Owner's Name__ -1 `��, ------------------ --------------------- --- Phone •---- - _ :: _. - - - ----- Contractor's Nam - - ��`4 4 k ��-- - -�-�- - ..----- ------------------- Installation Phone-----• _IP will serve: Residence//� Apartment House Commercial ❑ Trailer Court L] Motel E] Other E]Number of living units: _J-___ Number of bedroom �f . . Number of baths -/_____ Lot size ---/ S'-.2 __,� !� Water Supply: Public system Community system ❑ Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay:Loam ❑ Clay ❑ Adobe Hardpan p Previous Application Made: (If yes,date__..___.__,...___) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No se or cesspool permitfed if public sewer is available within 200 feet.) ek: istance from nearest well________________Distance from foundation_____.--___-_____.Material:_.__-______._...--_________-_-- _____________0. compartments------------------ 1Ze-------------------- -------Liquid det---------------- ---------Capacity-••-------------------- gZla stance from nee est well. .. . -- Distance from foundation__ __�� - __.Distance to nearest lot line._/-a--_-- umber of lines!______ ___ Length of each linei Width of trench_-. .------ jype of filter materia . Depth of filter material-__! _:�F Total length__-------------- � - e it Distance to nearest well__;_ - Distance from oundation__-.. f� or --� -- f � Distan„ to nearest lot line___ Number of pits--- -----------------Lining material- -d-G/ ---.-.Size. Diameter--- ' - - Depth---�i�----------------- Cesspool: Disfance from nearest well-----------------Distance from foundation___.__.._- ------.Lining material---------------------- ❑ Size: Diameter__-# ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weft___________________________________ _____________Distance from nearest buildin ❑ Distance to nearest lot lire----------- --------- --------- 9 -------------------------------- Remodeling and/or repairing (describe)_-----_------------ -------------- - -------------------------- --------------------- ----------=------------------------------------- -------------------------------------------------------------I ------------------------------------------------------------------------------------------------------------------------------------------------- - • 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, d rules and regulations of the San Joaquin Local Health District. (Signed) eUar� ifir�t --------------------------------------- Contractor) SEPTIC TANK S�RVICrE -'-----'---` --�- - - ---- By:.2e1-l5—E- �iner-A HLLb:3841---------------- - +�e-r = {Title) ----- ----- -- ..... ------- (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., an be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-___-.: - - ------- - ---- -------------�--- � --------------- ---------•----- - DATE.- ---� ---�_l- REVIEWED BY--------------------------------- ----� -- DATE__UILDING PERMIT ISSUED-------------- - ------------------------------------------------------------------------------ ------- ----------=----- --- - --- :.-_.._ DATE-- ------------- -------- -- --- -- ------------------------------------------------ Alterations and/or recommendations:_ -...___ -------------------------=-------------- ----------------------------------------------------- ------ --------- ----------- -- -------- -------------- ------------------------ ------------------------ -- FINAL INSPECTION BY:------------- -------------------------------------------------- Date.... --------- ---- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseiton Ave, 300 West Oak Street 124 Sycamore Street 205 West 916 Street Stockton,California Lodi,California Manteca,California Tracy,California f