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V --- , APPLICATION FOR SANITATION PERMIT Permit No. _ APPLICATION - _- �) ( omp Clete in Duplicate) -tt � (AComplete Issued Applica+ion 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. i � JOB ADDRESS AND LOCATION-----f7._ 1� ,S " -G., ez l .. Owner's Name------------ ' -•--- � ------------------------------------------ - -------------------------- -------------- Phone.-.-----------/6�.---- G ,r _ T ---------Address-------------------------- Phone- Contractor's Name------ 5�. Installation will serve: Residence Apartment House ❑./ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _,1--- rhber of bedrooms _!_-_- Number of baths -_/-- Lot size ,�+�.�--_____-�.�xt .......... Wafter Supply: Public system Community system ❑ Private ❑ Depth to Water Table,,?d ft. ' 1. � Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ardpan ❑ t Previous Application Made: Yes ❑ No 2--'-N-ew Construction: Yes ❑ No "( l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � �� A f (----- -.JAG Septic Ta Distance from nearest well_;?-��_Distance from foundation---/�_-.-------Matenai____________---- ________z_ r. No. of compartments...eg------------------size � �<- ------Liquid depth--- - -`--------.CapaCitY-: - __.___._ Disposal Field: Distance from nearest well4on_e---.-Distance from foundation__---2-59 to nearest�l t ne--�d-.`.... Number of lines_____.____------.-___- _._.__Length of each line.��------------------Width of trench.-_-__� '._-.___-- - Type of filter material 's --Depth of filter material--/<? ,.f'_-_._....Total length___ Q_' Seepage-Pit: Distance to nearest well_14CALP____---Distance roation_--. -a.�-..Dist nce to nearest lot line----Z--------- Number - -_- Number of pits.../--....________Lining material-(1 t jr-fSize: Diameter_01---__--_.Depth-- _______________ Cesspool: Distance from nearest well-----------------Distance from foundation.-__-----..-----...Lining material---.--------------------------------- ,• -- - ----------------` -------------- Liquid Capacity----------------------------gals. ❑ Size: Diameter- --------------- -------------------Depth---------- Privy: Distance from nearest well-------.-----------------------------------------Distance from nearest building-.--_________------_----__.-_-.._-_-.-. ❑ . 'Distance'fo nearest lot line------------------------ -------------------- ----------------- --------------------------------------------------------------------- !/ Remodeling and/or repairing (describe):-------------------------------------- -------------------- •-----••-- •-------- --------• Mill ----------------------------------------------------------------------------------------------------------- ---------------0------ E _ f__ _. ___ /t---------------- _ ___•-------------------------------------------•_-------._------ ---------`-------••---------------------•--------"----- ------ I hereby certify that I havere ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local He_a#h District. DAY&MIGHT Septic-Tank_Seri►f�@ .r. t..A- -------------- - �ifoar Contractor) (Signed).__..---- 130b So.Eldorado HO 2-7046 ��a 1 -- - ( ) BY� ----- - 5#ock#art;�a{if: ------ Title -----� � ---.-�`----------------- ------------ (Plo# plan, showing size of lot, location of system in relation to wel s, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------- --- --------------- ••------------•---------------- DATE-- ----��/---------- --- •--•-------------------- REVIEWED BY----------------------------------- i DATE BUILDING PERMIT ISSUED------------ ------ - ------ __ DATE-- =- - Alterations and/or recommendations:__ .,,.� -------------------- -----•-•-------- --------•-=------------------------•---------- - ••- t ------------------------------------------•------------------ --------••---------------•-------------------•-•----------•-------------- -----•------- ------------------- ------------------- --------•-----------•--------------- --------------------------------- ------------------------ -- - -------------- f-- •---- --= Z -----------•----- ------- --------•------------------- -------------------- ----------------- Date---_4 FINAL INSPI=CTION $Y:--------------- ------------------ ' ----------- ------------------------------------ SAN -------------- ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California E."-.-9-2M 14-6--U- ,2-54 4