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APPLICATION FOR SANITATION PERMIT Permit No. ._� (Complete in'Duplicate), 7 ?10 t * 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------------------/0-. �7.------ ` t" -- ------- = - Owner's Name----------------------•------�Y �A---------------.�__` �0 Q __ w ------------------------------------ Address ,. - Address--------. -_ � ---- ------------- - ----- ------------------- Phone --- Contractor's Name___________________ ___ = --------`�� Phone--- _X8-7 1r' Installation will serve:' Residence partment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ Number of living units: __/-___ Number of bedrooms . umber of baths ___ _ Lot size'.----- 2,-p---------------------- Water Supply: Public system [9- Cnimunit9 system`❑°'"Pri�,ate7❑' Depth-to`Water�Table'-------_ ft."�^`" Character of soil to a depth of 3 feet:, Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam Clay:❑!.Adobe E}!Hardpan ❑ Previous Application Made: Yes [ 'o ❑ New Construction: Yes ©�No ❑ �V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11.4 ' Septic Tank: Distance from nearest well_____________ _Di�tan.ce jrorri foundation-------------.---._.Material-_____________..__._..______________..____-_____. No. of compartments-------------- „Size-----... Liquid depth ------ Capacity.... :------- .' Dis osal.Fiel ,Disfance:from nearest well-----------------Distance from foundation------------[_...._.Distance to nearest lot line__:_.___.._._.__. I _____-- --.Length of each line----------------- --------Width of trench---------------------.-------- Type -- � Number of lines------------------- - -- --- a Type of filter material_______...___.__._____-Depth of filter material-------- __..Total length_____________________________T__:.�r. Se e Pit: Distance to nearest is tan my Jo nds zDi� {i_-_-._ Distance to nearest lot line__.__ _3___.__ , Number of pits-- -- ------------Lining material____-. er-------�--__.Depth-__.__:___' - --------- Cesspool: Distance from nearest well_-__ Distance from.foundation._.._:.._..___,..Lining material__:-,_._______________________________ I ----------------------- ❑ Size Diam�r-------------------------------------Depth---------------�--�,-. Liquid Capacity- :----------gals. - x �w 11 Privy, Distance from nearest we€I---------______________._-_____----------------Distance from nearest building'___:___.___-'___.____-_____._____.____- 1 ❑ Distance to nearest lot line----------------- . -- -- .. -------------------- Remodeling --- ---------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------- -----=-----=-------- -- F m ...__.__.____________________________----------.--------------------------------_______.__.__..........-__............___...._-__________.____-_______-__--__-_.______--____--._______----___..__.__._.______-.._.__.__...____ I hereby certify that l have prepared this application and that the work will be done in accordancewith San Joaquin County ordinances, State laws, and rules and regulatio of the San J0100 j f4gWith District. . F Septic Tank Service .. (Signed)-----------------------`----------=-•------------------------ _ ----Y205-Sm-11dwrada----H02-7046---------------------------{Own or Contractor) ' Stockton Calif. _ /�� By=-------------- f-- ----- ----- -- .---------------------- ----r----- --------------(Title)---------- '"�'��a ------------ (Plot plan, showing size of lot, loc on of system in relation to wells, buildings, etc., can be placed on reverse side).. i FOR DEPARTMENT USE ONLY '. _ r APPLICATIONACCEPTED BY-------- ----------------------------------------------------------------- DATE----------------- ----------------------------------------- REVIEWED BY DATE _ 4 BUILDING PERMIT ISSUED--_-____._ ____ � ""� -- - ---- -- ---- ----- ---------------------------------------------------------------------- DATE.-----._..,..-=----•-------------- -------------------------- Alterationsand/or_recommendations------------------------------------------------ -------------------------------------------------------•-----•-•-•------------------ --. ------------ - L _._____-__.__.____._________ _____ ___ _ .__-_._... ' _ __. _ ----_____.__________...__________._-----_________________-_-_-_-_--_________-.-_- /1/y� 1A�y CZ FINAL INSPECTION BY:------- ._-- ------------------------ -------- Date.........(.__�_��-_�," " . SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 12-54