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APPLICATION FOR SANITATION PERMIT Permit No. ..[�.*! 9 (Complete in Duplicate) �p P_'A Date Issued ----.- ��.- Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This 1pplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ C-__-_---CA, — " Owner's Name -------- Phone------------ Address---------------------- ----------------------------------- --•-------------- --- --•- --- Contractor's Name-..--__ • r a7t n, ------ --- Phone__ •'T t1 ❑ ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial Trailer Court Number of living units: J__ Number of bedrooms :"umber of baths __-L Lot size ._- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Send ❑ Graver ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permitted if public sewer is available within 200 t.] Se„ ,110 !Tank: Distance from nearest we704"1150C Distance from founds ion- ---- ---------Material-__------_----_ No. of compartments------- ----.-Size------------------ -------Liquid Fdepth--------------------- ----Capacity--- Dic sal eld: Distance from nearest well-----------------Distance from foundation-_---------_------.Distance to nearest lot line----------------- Number of lines------------------------ - -------Length of each fine-----------------------------.Width of trench------- --------------- -------•-- Type of filter material...... --- - -Depth of filter material-----------------'-Total length------------------------------------------ Seepage Pi Distance to neares well--- .-.-Distanc&rc m foundation_- Q �" -..-..D Distance to nearest lot line-. ---_.. ❑ Number of pits---- ----------------Lining material- .---.-_-Size: Diameter------3�6-_ ---Depfh__2v c_4 _--- -- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------ ❑ Size: Diameter-------------- -----------------------Depth---------------------------• - -----------Liquid Capacity-----------------------------------gals. Privy: Distance from nearest well--------------------------------------------.-..-Distance from nearesf building ❑ Distance to nearest fol line----------------------------- Remodeling and/or repairing (describe):---------------------------------------------- ---------------------------------------------------------------------- ----------------------------••--------- ----------•--------•--------•------- - ------------------------------------------------------------- -------- ---------------------------------------•-----------------------------------------------------------•--------------•------•----------•-•-------------•-------------------••--•---------•----------------------- I hereby certify that I have pr�eppared this application and that the work will be done in accordance with San Joaquin County ordinances, $ ws, and ruID1a'i7d8rN4G1i'Xs of the San Joaquin Local Health District. Septic Tank Service (Signe,)___--... . 1206 So.Eldorado HO 2-7055 r Contractor Stockton, Calif----------------------------- -- ----- ---------------------------- ] By:------------=-----------•--------- ----------- ----- -- --- Title { ] (Plof plan, showing size of lot, location of system in relation wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- DATE,=--------------------- -- ----•------------------ --- REVIEWED BY---------- - DATE--2-•--------- ---------------------- BUILDING PERMIT ISSUED----------- ----- -- ---------------- - DATE.--- - A terations and/or recommendations:-------___------------------ -•----• •-------•--------------------•------•----------•--- �.� �. �Q - ------- ------ ------------------------------------------------------------------------------- FINAL INSPECTION BY: ----------------------------------------------- Date--- .0 �JJ C -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oal Street 132 Sycamore Street 814 North "C” Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-214 ;45446 ATWOOD 12-54