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-t APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued --�Gl--�� Applica+ion is hereby(made to the Sari'Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliant� with County Ordinance No. 549. 1 495 9�est 9th.--Street,_.__Stoc�s._- -•----------------•- JO$ ADDRESS AND sLOCATION- Phone----------------------- Owner's Name------------------------------•---- s�reth_. + zke----------------------•--•--------------•---•---••-- ---------------- --------------------- ------- 4 Address----------------------------------• -- 2794fi IDays Septie Tank Service•.---- ----------------- Phone C Name------------------------------ ❑ & 9�8cery i - Commercial ❑ Trailer Court ❑ Motel ❑ Other re Installation will serve: Residence ® Apartment House-❑ Number of living units: _-1--- plumber of bedrooms - - Number of'baths __ -_ Lot size __ - -- --��-• -------------------------------- Water Su 1 Public [3 Community system El Private C] Depth to Water Table -------- ft. Character of soil to a depth of 3 fe PP y' system, Cla Loam El Clay E] Adobe ® Hardpan C] No Sand F1 Gravel ❑ Sandy Loam ❑ Y Previous Application Made: Yes ❑ No [� New Construction: Yes F1 No KI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} ++ liedwood 800 al Se tic Tank: Distance from nearest well__ ane---Distance gf�r;m�IoundatiL quid depth-- ,Material------ Capacity-8 No. of compartments---------- ----- Size- _. r D•+sposal Field Distance from nearest well----------------- of reach liom ne anon__:_--.-_---__.--.W dthGeofttrench est lot line- .------_---,_- ❑ Number of lines________________ Type of filter material-___-"___________________Depth of filter materia!____---- - Dostancegtohnearest lot line----------------- Seepage Pit: Distance to neaIest well----------------------Distance from foundation-------------.------ - Depth----------------------- Linin material-------------------- --Size: Diameter-------------------- 1k ❑ Number of pits---------------------- g Distance from nearest well_________________Distance from foundation____"_______-___--. Lining material------------------------------------- Cesspool __Liuid Capacity._,_ ------- q Depth_. E Size:.Diameter_ ,� .— � — -; Distance from nearest building_---. --- -------- Distance - ---- Distance from nearest well--------------------------------------------- "-- Privy: ----------- Distance to nearest lot line---------------------------• -------------------•------- -----------•------------------------ � Nevj septic tank replacing defunct cesspool- ---- ----- Remodeling and/or repairing (describe):-____--------------------- _________- --------------•--- •------•-----------------•--------------------•------ '----------•--•----- I hereby certify that I have prrepared this application and that the work will be done in accordance with San Joaquin County i ordinances. State laws, and rules and requla ns of the Sa aq i ocal Health District. Septic Tank Sere - ----------- (Signed) --------- �ay s Sap � -- ---- -- -- - - -- - - - - tSi ned -- - ov ner' ---- ----------- 9 -- (Tifie)---------------------- By:-----------------•----------------------- =-------------------- - --- - -------- (Plot pian, showing size o{ lot, location of Sys +n relation to we11s, build'in , etc., can be placed on reverse side). FOR DEPARTMENT USE O LY ------------------- - DATE --------------------- -------------------------------- APPLICATION ACCEPTED BY... --- � ------------------------ ----- DATE_ ----------•--------------------------------------- REVIEWED ------------------ - REVIEWED BY-----------------------------!;� --- --- -------- - DATE-----.V_..----------•----------------• ------------ ------ PERMITISSUED------•------------------------------------------ ------ - -------------• ----------------------------------------- Alterations and/or recommendations:... .. ................ - ------------------..--___._._.__-___._.----_..- -------- ------------- ------------------ ------- FINAt INSPECTION BY:__ -- ' --------- ------------------------------------------- SAN ---------- -------- ------- --------------SAN JOAQUIN LOCAL HEALTH DISTRICT i32 Sycamore Street 814 North "C" Street 300 West Oat 54ree+ Tracy, California 130 South American StreetManteca, CaliforniaCiifi Stockton, California Lodi, California Lr,-9-2M 145446 AYWODO 12-54