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APPLICATION FOR SANITATION PERMIT Permit No. ._..-_-__3._4' .i, (Complete in Duplicate) Date Issued .__I_ 3SGr T plica4-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. 4 JOB'ADDRESS Owner's Name-------- Phone Address -• ��-- Contractor's Name------- /` `__ ; - �� Phon . __ _ _/ • Installation will serve: Residence l�' Apartment House [ICommercial ❑ Trailer Court ❑ Motel ❑ O}be, . ❑ r Number of living units: -_. _- Number of bedrooms _!J_ Number of baths - --i�ot size -__ _ >e Water Supply: Public system ❑' Community system ❑ Private [ Depth to Water Table Character of soil to a depth of 3 feet:- Sand ❑ Gravel n Sandy Loam ❑ Clay Loam ❑ Clay El Adobe [s�`Fiardpan ❑ Previous Application Made: Yes 0 No ❑ New Construction: Yes ❑ No ❑S TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.} Se is Ta Nof n c from nearest well----------------- from founclation_�Y- a ce e pth--.Material -------•--------------`---.. ompartments Size ` Liquid depth - '---- ----- ----Capacity Distance from nearest well--------------- -Distance from foundation------ '------Dis#an e�to nearest lot line------------ o{ lines Number ... ; osa ___ _____________Length of each line-__._ ------,�. =..._ - Width of trench . Type of filter material-------------------------Depth of .ter material-----------------------Total length---.- ;---------------------------------- om Eit: -Distance to nearest well-/' d_�---_Distance om f unda+ion__ f..Dist nce to nearest lot line_ Number" f pifs........................ Lining material- - --- ----- -----Size: Diameter.__-r�-----Depth �---------_--- Cesspool: Distance from nearest well------------- Distance from oundafion___---------------_Dining material-.___-_______---______--_ c ❑ Size: Diameter------ --------------- ---------------Depth------ ---------•----- Liquid Capacity gals. --------------- Privy: Distance"from nearest well------------------------------- ------------------Distance from nearest building--------------------------------------- • r ❑ Disfance'to nearest lot line-------------------------------- - ------------------- Remodeling and/or repairing (describe)____________________ : -------------- _ _____________________________________________ Zi __ ____________________________----------------------- __________________________________________________________________________________________________________________________________________________________________ __--- ------ ______ __________ _ _ __ _ I hereby certify that I have prepared this application and.that the work will be done in accordance__with__ ________ San Joaquin Co_unty_ _ _ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed. ' DAY &NIGHT -------------Septic--Tank_Ser—Selpfic--Tank-Ser-Aco---------------------------- . R" M 1206 So.Eldorado HO 2-7046 - '----- - ---------------- ------ -- --------��' Contractor) � -- ------(Title)---- _ ---------- (Plot plan,- owing size of la location of system in relation t wells—buildings,s, g ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- - - ----------------------------------- DATE - --------------------------- REVIEWED BY = -- --------------------------•-- ------------------------- DATE-------..� BUILDING PERMIT ISSUED-------------------- -----: DATE---- Alterations and/or recommendations: ._.. -------------------------- ---------------------------- ----••---- --- - ----- ----- ---- _... -------•------------ ------ - - -------- ---- -•-- FINAL- INSPECTION BY:----'- 'Date..) i� i 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--S 1a 446 ATWOOD € SYR F