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Y 5� APPLICATION FOR SANITATION PERMIT Permit No_ _____7_5_/ (Complete in Duplicate) S/r,� `� Date 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. JOB ADDRESS AND ++ LOCATION_.! J--- ; SI ----�-,I ---------`'�` Owner's Name----------6e.t'•---- �`/ lJ f -------------•---------------------•--------------- ................ Phone----------------------------------- Address..... ---------------------- 75� ---------------------------------------------------------•-•------------•----------------------------------"-------------------------------- ------------------------------•--- ' r/�i� � " �vCContractor's Name--- .... .. - ------- ------ ...__.. Phone- ----- e - �- . . Installation will serve: Residence [3/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms—'?-_ Number of baths __-/`:,�!_ot size ------ 1.7"t--__-_____ Water Supply: Public system ❑ Community system ❑ Private 19th to Water Table `��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ©—Hardpan ❑ Previous Application Made: Yes ❑ No 0/New Construction: Yes ❑ No [].--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeVtic Tank: Distance from nearest well_________________Distance from foundation__._________-____._.Material---__-__---_.___----__.____________.___---__._.. No. of compartmen is----------------------Size-----•-------------------------Liquid dept------------------------Capacity----------------- Disposal Field: Distance from nearest weli ..._Distance from foundation__+�`. __.__.Distance to nearest lot line_______. [�}J Number of lines---- ---------'----- --- -----Length of each line--- -------------Width of trench.- _ rf----------------- \y� Type of filter material__ _ ---_------ '-._-Depth of filter material--__ '-�l__-__Total length____ __f______________________ See�pag�e Pit": Distance to neares well,/t2/'-----Distance fro!_b- m m foundation------ Distance to nearest lot line__ Number of pits.... ______'-'-'"--Lining material. _ ----..Size: Diaefer-_--- p-----.Dept's- .,�------- Distance from nearest well_________________Distance from foundation.-.-.,--.------_-__.Lining material--.-_-_____._______.____.____________- Cesspool: � ❑ Size: Diameter------------------ -- - --- ----------Depth---- -----------------------:----------------------Liquid Capacity-.--------------------------gals. Privy: Distance from rearest well_...__:------------------------------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line---------------------------------------------------•--•------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------------------------------- --------------------------------------------- -------------------- --------------------------••-- -• - --- --- --------•----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and AN,if of the n .Joequ'n Local Health District. Septic yank S?rvire (Signed)_ P ________ Owner and/or Contractor - ---' ----- ----- --' 706 5d.�dorddo___ -2-7�' ------ - By- .................stockan._q if. ---- ----- -- - -----'---------- -----•-- (Title)---------- -----------••---------------------- ---------------- (Plot plan, showing size of lot, location of system in lat' n to wells, buildings, etc., can be placed on reverse side). F EPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- �""� ------- -------------------•----------------------- DATE-- VfZt---------------- - REVIEWED BY--------------------------------- ---------------- DATE----- BUILDING PERMIT ISSUED--• - DATE----------- --------------------------------------------Alterations and/or recommendations:-------•---- --------- • ----;--�------"-_.._----•---------- --------------"----------------•---------- ----- f--� ... ---------------`7".... -' - - A FINAL INSPECTION BY:------- -'- L----------------------------------- Date--'-'-'- r 9- 5-_SO ------------------------- ---------------•-•- 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 Er-9-2M 145446 ATWOOD 1Z-54