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rum vrrii.[ ubt: — 9" � ....... ••------ ................... ._.. APPLICATION" FOR'SAN_ITATION PERMIT Permit No. ... . . ... - (Complete in Duplicate) (A ................... --------------- -- -- - .--- This Permit Expires 1 Year From Date Issued Date Issued __(.zL ram, DQ3 — — Gib Application is hereby made to the San Joaquin Local Health District for a per it to constructppd`nstall w k herein described. This application is made in compliance with County Ordinance No. 549. e ^��//�� , H rc W t Z7'� ,6 - JOB ADDRESS AN LOCATION._&,I .-�� - i�k�O� -�f�� h/�� •�i2,„�.: Owner's Na e.... ..._ ... Ph- ....._ Address . .... :.. ............ Contractor's Name...._... -_, ---- ------------------------....... Phone....7--------- ./ Installation will serve:a Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - -. •,- i Number of living units: . �� 1..._. Number of bedrooms .�Number of baths J___ Lot size ......��1`yQ. Water Supply: Public ystem El Community system ❑ Private epth to Water Table fp-G-lft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay❑ obe Han pan ❑ Previous Application Made: Ill yes,date....................)%.No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) * J i Septic Tank: Distance from nearest well- 7._..Distance from foun ion., `N�{� Material No. of compartments--A_.._.. .nn..._.Size t � „� iquid depth-_ 7._!1------_•.Capacity......... . Dis I Field: Distance from near st well/�!G!._�_Distance from foundation. � ..__.._Distance to nearest loft line_. ...:..... Number of lines... �.I. Length of each line...-_ Q.r....l ..Width of trench_ -2_44!d_....;--__�,•- 411 Type of filter mat eria -Depth of filter materia�----Z_/�..-------Total length.......................��------- Seepage Pit: Distance to near t well. Q. •_... Distance from oundation..... : / ---- 1QQ..__..Distan`e to nearest lot line....w�W.. Number of pits..................Lining material. p _Size: Diameter.y .rTj -_-_Depth- .f.. i Cesspool: Distance from nearest w II.................Distance from oundation--------------------Lining material........................ .- ......._ ❑ Size: Diameter. . - D P ----------------------------------------------------Liquid Capacity.......................�.--gals. Privy: Distance from we elp ,..__ ... . .Distance from nearest building ....._1........... ❑ Distance�}omearest o lin r Remodeling and/ �r�ai�int':(�`escribL)y.... --------- -------------------.- .-•-_--- �. -------------- -...........�....-•---• .. ` ---••-----••-----------------------�.......... L./ ----•----- -- --; --- ------ ......................................... ........ ------..... ._........ --.----- ------ �--------------•--•---------•-•--- ------.. --- ------ -•---_------- ..................................... --..._........................---- t I hereby�eertify that I have prepared this application and that the work will be done K"V ordance with San Joaquin County ordinances;tState laws, r rutb0hd regulations of the-San,Joayuin,Lo4I Health District- ------ q�`9 ... - (Signed)- Q �l ...t` -- .------- ••-- - : SEPTIC TANK SERVICE Contractor By:.-�9�5 E�Ainer-Ave Y.:..Hm_b ----------- - ---------------- .. . _1.:.._.......r�� .(Titld�'_........�L_............. (Plot plan, showing size of lot, location of system in relation t wells, buildiing , etc:, can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............. - ----•-••- -. .... DATE._... 5-2...�1 ....- REVIEWEDBY ..............I.................... • •-----..........-----------------• ..-- DATE....................................... BUILDING PERMIT ISSUED....................•--..................._._..--.•... -----.....................--------- DATE. •. ••------_.. ....---.----- .......... AI ons an i p recommendations:.. .' ..rc_.0./t'-------(Q - . •....--------•-.•. K�®.-.. .............—... ....'..: . . I ---- _................ ............ ..---- .-----•• --....---.... . FINAL INSPECTION BY: C.4v.................. Date....... '-c'J •.--6 - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elten Ave. 300 west Oak Street 124 Sycamore Street ;0 205 West 91h Street Stockton,California todf,California Manteca,California Tracy,California F.p.Ca.