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FOR OFFICE USE:1:2 / . APPLICATION FOR SANITATION PERMIT Permit No. t..2-.. -.`.....` ---------------------- ---- � (Complete in Duplicate) J - Q� Date Issued .__ ............... -_------ This Permit Expires 1 Year From 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 Ordinn ce No. 5549. ,, / JOB ADDRESS AND LOCATION "7`I '`°� --`z--- � Owner's Name---------�L//A Z V--------------�7f4.pl?--63-�--------------------------------------------------------- Phone --••----.� Address---------------- .......: ` ----------------------•---------------------•--_- -----------------------•----------...-----------------------•--------------------••-------------- Contractor's Name- --__f-• f � _� __ r_.._ ve----------------- '2 .0!/6 f Phone _.. _...---7....T".--- Installation will serve: Residence fZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedroom5.�___ Number of baths _ _ Lot size ____ _`__�4._.. -.--_--------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeV Hardpan ❑ Previous Application Made: (If yes,date____.___- .......) No ❑ New Construction: Yes ❑ No� FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �pfi Tek, Distance from nearest well-----------------Distance from foundation--------------------Material_____________________._____-----._-_______.____. ll` . No. of compartments--------------------------Size..._ --------------------------Liquid depth-------------------------Capacity---.------------------ Dis osal ieI0: Distance from nearest well__4_C�T1:4�_Distance from foundation.-__ .'�__.._.Distance to nearest lot line_______._._.. Number of lines------- ------__------___ _____Length of each line- �p.'------.-- Width of trench....�.�'-.____._-__--- ¢ d9 Type of filter material. __L_-�_....Depth of filter material_____ _`______Total length----------2.9_'___________ _ __ ___ - Seepage Pit: Distance to nearest well_. --- Distant from foundation...�a_r._..Distance to nearest lot line----- ��... Number of pits.___4,t------------Linin material. °_g�k------Size: Diameter___ZZ__..____Depth__..,2i_a1�_.11.___ Cesspool: Distance from nearest well------------------Distance from foundation-------------------.Lining material_-___-_______________________-..._._ ❑ Size: Diameter---- --------=---------------------.Depth--------------------- -----------------------------Liquid Capacity------ ---------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building---------------------------_-------------. ❑ Distance to nearest lot line------------------------------- ------------------------------•------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe)------------- ---------------------------------------- -------------------- --------------•--- ----------------- ---•-- •------------ c ..................... ----------------------------------------------- -- . ...... ... . ......... ......... -- ........... ---- /� ----------------------------•--------------------------------------------------- ---------------- ---------------- ------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the wo will be done in accordance with San Joaquin County ordinances, State lawMitd rules and regulations of the San Joaquin Local Health District. (Signed)----------- j -------------------------------------------------------- --- --- -----------------•-----=----------- Contractor) B �PT1C TANK SEhRVIC� Tale y29Q� : irer Ave:; i E E�; -----•----------------------•---------------- 9 (Title) } (Plot plan, showing size of lot, location of system in relation to Is, uildin s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------/--,2 f rt>__.,-------------------------------------------------------- DATE------------ ----------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE_--------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- ------ DATE...---------------------------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------------.........--------.-..---..___------_---------... --------------- Iz- ' 2----------------------------------------- -------------------------------------------------------- -------------------------------------------------------- ----------------- ---------------------------------------------------------- ------ ----------------- FINAL INSPECTION BY:------------- 47t- Date-------------------------------- �i d----------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 Sough American street 300 Wes}Oak Sheat 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 AEVIBED 8•59 r.P.DD.2M 6.6D 5