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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applical-ion is hereby made"fo the San Joaquin Local Health District f r apermif to construct and install the work herein described. This application is made in compliance with County Ordina e N JOB ADDRESS N LO ATIO ------ ---- ------ - -- -- --- - --- - ---------------------------- ------------- Owner's Name----------- ----- ---- -- ------- -- ------- . ..... --- --------------------------- ------------------------------------ Phone Address-------------_---- -------I — -------e.127--------•- -, ' --- ----- -------- 44--wx---------------------------------------------------- ------------ Contractor's Nam EL b(52--tle ------'5� ----- --------------------1- Phon;�K�(�_v Installation will serve: Residence 5ge"Apartment House 0 Commercial El Trailer Court E] Motel [:1 Other E] '�Lot size ----417 e_ Number of living units: --- Number of bedrooms'.. Number of baths t -sem_ I ----------- Water Supply: Public system E] Community system E] Frivate 4i--1yepfh to Water Table _Off. Character of soil to a depth'of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam 0 Clay Adobe 011"Hardpan E] Previous Application Made: 1yes El No 9--- New Construction. Yes �o El TYPE OF INSTALLATION AND SPECIFICATIONS: ?I (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic nk: �D;stancejrom nearest w6l_57_Z?_.-__-Distance from foundation > % - ---4 --.---.---.Material_--- -------- No. of cmlompqrfimen'ts-�_1_7;�.7y_ Sie--SZ'fk 34 U *,f d ---------- ----------- Liquid clep�k---J_7�2_----------Capacity_,?40_ A_Z4 Disposal Field. DisfanciF'frbrn nearest DisfancAll foundation--/ ------__--:Distance to nearest Numberof lines----- ----/---- Length of each line- -Width of trench'.aZ5,C T ------- ... Type of filter material's�- 4- a Depth of filter material-- --------------------- ------Total length-_- ... Seepag if Distance to nearest well,/ --—-----Distanc&qp foundation____'2_4_. .-.Distance to nearest lot lin I; --- 10------- _r�,N_CE e----6---------- Number of pits------/.......'---,,Lining maferiall------ --- Size: Diamefe ----Depth___ ;i_ �--_----__--- um Disi-ance.1from nearest well ----.---Distance from foundation.-._- -----------Pning material-------------------------------------- 0 Size: Diameter---------------------------_:-------Depth-.---------------------------------------k-------:Liquid CapacitY----------------------------gals. Privy: Distance 1; .:from nearest well------ -------------------- ---------------------Distance from nearest building--------------------------- -------- F-1 Disfancelfo nearest !of line.-------"-------- -+ --------------------------------------------------------------------- -Remodeling and/or repairing (describe)---------- ---------__ - ------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------;I "----------------------------------------------------------------------------------------------*-------------------------------------------------------------------------------- --------------------------- ---------------------:--------------------11*......*--------------*--------------------*-------------------*----------------I---------------------------I------------------------------------------ ------------ ------------------------ ----- -------------I-------------------------------------- -------------------------------------------------------------------------------------- ----------------- -------------- I hereby certify that I h;ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Lws, and rules l3nAr Mftof the San Joaquin Local Health District. AY Septic Tank Service (Signed)-------- --- ---- --- - ----- 206-Sd.-E1di5Fffdo---H!10-24046----- -------- - ---- ------ --------------- Contractor) By:------ -------StqAtm_-Calif -------------------------- -- --- --- ------(Tif le)---1 4_ 4--Z -0----------- --------------------------- (Plot plan, showingsize of lot' location of system in relation to Is, builiclings, c., can be placed on reverse side). . sl FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ------- ------------------ ------------------------ ---------------------------------------- DATE 5k ----------•----- ----------------------------- --- REVIEWED BY 1i ----------------------------------------------- ------------------------------------------ DATF__..4 BUILDING PERMIT ISSUED_'! 1 -------- � ------------1-1--------------------------- DATE.---"?,N_ Alterations and/or recommendations:----------------------- -- ic — --------------- -- ----------------------------------------I—------------ ----------------- - -----------------;in- (------ --------------- ----------••-•------ ---------*--------- *----------------------------------------------------*---------- ----------------------- -ir------- < ------------- -------------------I----------------------------------------------------- ------------ ---------------- ---------------- ----------g --------------------- --------------------------------------- --- ---------------------- � el � --- ------------------------------•----------••---'------- -------------*-*-----------------------------------------*---Z--------*---Z----------- -- ---------•'------------------------------------ -------- ------------------------- ------------------ FINAL INSPECTION BY:___I_ ----------- -I-------�-- --Ls _ Date ----------------------------------- ---------------------------- - --- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 1:1 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California EF---9-2M t4G446 ATWOOD 12-s4