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APPLICATION FOR SANITATION PERMIT Permit No. .1.2 (Complete in Duplicate) Date Issued Application 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 ante UqeJ49. JOB ADDRESS AND LOCATION.. ;�} Owner's Name-------------a- � ,'----- ------- ------------------------------- --------------------------- ---------------- Phone--- ---------------------------- Address. ------------- -------- -------- ----•------------------------------------••---------•--------------------•---------•----------------------- Contractor's Name-------------- -' - %- • -•-------- C•----. ,---------------- -- Phone -;? Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._1--_ Number of bedrooms ___1-14umber of baths ---- Lot size ___/�_w-A Z_-------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ � ��r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ra y Distance from nearest well_________________Distance from foundation_._-----------------Material------------------------------------------....... i No. of compartments-_-- ----- -- ---- -- - Size--------------------------------Liquid depth-- ------ ---------------Capacity----------------------- Disl Fi Isl: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___--____________ Number of lines-----------------------------------Length of each line------------------------------Width of french------------------.---------------- Type of filter material ___._ ------------------Depth of filter material-------------___-------Total length---------._________.____________________.- Seepage 1t: Distance to nearest wefl_A�---------Distanc rom foundation_, -A.:'.___D'sta�ce to nearest lot lineAP_�____ Number of its----/_______._- Linin material_ Size: Diameter___6 °t 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-------- ----------------------------------------••-------•---------- Remodeling and/or repairing (describe)-------- a -- ----------- ----------------- ,__.._ ----------------------------------------------••-------------------------------------------------------•------------------..-----_-----------------•------------------ -----------------------------•------------------------ ------------------------ - -- ----------------------------------------------------------------------------- ------------------------------•------•---•--------•-------••-----------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- (Oww°+ yr Contractor) Septic Tank Service By: _ - ....U06, f1tlorada p.2=7 Ab -..k------�'`I----------(Title)---- Q'` `'------------------------------- -------- (Plot plan, shows . ize of lot, locrtiwkitt; �,in re�afon to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BYE-- ----------- ----- -------------- --------------- ------------------------------------------- DATE,_ ------------------------------------------------- REVIEWEDBY----------------------------- i- --------------------------------------------- DAT _ -- BUILDING PERMIT ISSUED------•---. �1 DATE----- ---------•------- ---------------------------------------------------------------------------- - --------------------------------- Alterations and/or recommendations------------------- ----------- --- ------ -------------------------------------------------••----- ?' ------------------------ = �� - - ---- --------------------------•---•-------------------------•-------------- --- --- -----•------ ---- FINAL INSPECTION BY:_.___. - 1 -- �-� ----- ---------•---------------- Date-- �- -•--j---�-- ------ -------------------•-------------...--•- 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 ATWZDD 12-54