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1, ra APPLICATION FOR SANITATION PERMIT Permit No. ... 4-L t 0 (Complete in Duplicate) /"Aa// 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 AN O ATION- ZD 3 P•!Zd�c' ------ ------------- t Owner's Name---•----- -- ....••�� 1 ''S Phone Address_c ,&.-•------•----•--•-----•---------------------------•------------------- . Contractor's Name f`.oe !, -------•-�`--r--------�VCr--------------------------------------------- Phone.?!*-t,7i..'� Installation will serve: Residence UKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 7---"'Number of living units: ---r`_ Number of bedrooms ._X Number of baths ...�ot size _.....1''1*-0......_-------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table lfvft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay oam,❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ A-7 TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k: Distance from nearest well-----------------Distance from foundation_-_-_----_-_---_-.Material____________._-.._.-_-.---___-----._.------.___-. No. of compartments-------------------- -Size----------------------------•---Liquid depth---------- --------------.Capacity-------------------^ 9 spos Id: Distance from nearest well ��__®.---.__Distance from founcla ---------Distance to nearest lot line...®_._. ^ , , Number of lines- _-/----------- ------ - -Length of each line_> P.. ..........Width of trench__A-S4'`__-_-._-.--__---.- 0�"'— Type of filter material... Depth of filter material__.��'r.._...__.Total length___._!,©�________._. ------------- Seepage ' Distance to nearest well_.. ...._---_.._Distant om �°undation---`4.._.._..Dist ce to nearest lot line ._.�____.... V Number of pits-.-.Z-.............Lining material. U_.----.Size: Diameter__ ......Depth._»Z __..___......_.____ 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-..---------------------------------------- ----------------------------------------------------------------------------------------------- ,r^` Remodeling and/or repairing (describe):------------------------------------- -------------•-----------•------•-----•---------------.._...---•------•--•-•-•--•••-------------------------•-•-• W --------------------•------•--------------------------------------------------.._...----------------------------------------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------•-------------------------------- ------- ----- -•-•--------------•---••----------•-----•--•------•---•-•----------•-----•------•-------------.....------...------------------------.....------------------.._.........•----------_...-- 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 rules and regulations of the San Joaquin Local Health District. DAY&NIGHT (Signed)_.._. --------------Septic-unk-Service------------------- -d�bui4i�dingstc., --- --------------------- (O ner and/or Contractor) 1206 So.Eldorado HO 2-7045 BY� (Ti+le) foc�ori;- a1'if:-----:--------- (Plot plan, showing size of to+, oca}ion o system in rela n to wells, can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY------------------------------ --------------------------------------- ---- DATE------- --------------------------------------------- REVIEWEDBY------------------------ -------------------------------- r*- ----------------------------------------------- DATE---------------- ...................................... BUILDING PERMIT ISSUED. �� ... - DATE -- -� ---- Alterations and/or recommendations------------------_ .�----.................................... -----------------------------------•---- - - -------------•-----------------------------= ---------------------------------------------------- -------------------- ------------------------------------------------------------------- --------------------- ................................ FINAL INSPECTION BY:.-------G.-� — Date 1 .� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD