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APPLL ATION FOR SANITATION PERMIT Permit No. ___`_7__`�___ __7 O (Complete in Duplicate) .Z 3 — Date Issued ___s_---------------- 4— 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 Or+ja.%nce No. 549. JOB ADDRESS AND LOCATION....2_1: *-?...... ___d-1_._..`F__` ' ___.1 �t`-!�_ _____, �j --- "� `` - ll -1-I -- :�e�n-----�"------------ ---------------------------- -- _---------------------- AddressOwner's Name__ �.�{.1_ 1'� !�_ _H' _ __ Phon ------ -� �^' n "�._ '2�t .�---•- ` Contractor's Name--- -o��. _-LQ/1��_ ��1/1_� Phone? �� Installation will serve: Residence Apartment House ❑Commercial E] Tr Court ❑ Motel 0 Other ❑ Number of living units: ___ __ Number of bedrooms __Number of baths _7Lot size -------'ie.J5 r•___ ...,...;.................. Water Supply: Public system ❑ Community system ❑ Private []bepth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel F] Sandy Loam E] Clay Loa ❑ Clay C] Adobe Hardpan❑ Previous Application Made: Yes E] No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. 100, ) Septic Ta Distance from nearest wel� _____.Distanee from fo ndation__ _B______.MatenaL..________-______ Ta No. of compartments----Z----_-______-___Size_a> ._-_a! _tQ.Q_ �Liquid depth___J-7.. ______Capacity.f'�____________ al Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line..._............. Number of lines---------------------------------__Length of each line----------------------,.......Width of trench___--_________________-____________ Type of filter material-_______________________Depth of filter material-----------------------Total length------------------....................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits______________________Lining material----------------------.Size: Diameter------------------.----Depth------_____,__,___--__-________ 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---- -------------------------------------•--------------------------------__---------------------------------•-•---------------- 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 rules and regulations of the San Joaquin Local Health District. DAY&NIGHT .- (Signed)----- SePtic-Tgsa_x._Service----------- -------- Ns�, ----- �---- j - ___ Title---- L�/l�S+ o Contractor) --- 1406 So. Eldorado HO 2-7046 By=-- --- _ ------------$t"Ittoni-C-alif----------- ----- (rifle) `Gt') (Plot plan, showing size of lot, location of system in relation + ells, buildings, et .. can be placed on rNverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ ---------------------------------- ------------------------------------------- DATE REVIEWEDBY-------- ------------------- -a ----------------------------------------------------------------- DATE... BUILDINGPERMIT ISSUED............ ------------------------------------------- ----------------------- ---------- DATE-- Alterations and/or recommendations:-- ------------------------------------ ------ .......................................................... ----------------------•---------•----------------------------------- --- -------------------------------------------------------------------------------------.._..-------------------------------------•--------------- - ------------------------------------------------------------- ------------ -------------------------------------------------------•----------------------------------------------.......................................... ------------------------- ----- ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- --------_--- ------ --- -- -----_____---------------------------------------------------------------------------_---------------- FINAL INSPECTION BY: '"" - ----- Date �4 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 ES-9-2M 145446 ATWOOD 12-54