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R APPLICATION FOR SANITATION PERMIT Permit o. - --- (Complete in Duplicate) 9' 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 OrdinancNo. 549. JOB ADDRESS AND LOCATION_._ _____ _.r_"___ ._--_ - --___._._." Owner's Name--------------- ---- --•-- -------------------- - - ----------------- -- ------ --- ---- Phone----- ------------------------------ y Address------------------•--- - 9 . -- --- Contractor's Name-- ------------------------ A\ + 4 r Phone d a� 6 Installation will serve: Residence 2---Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: ----/ Number of bedrooms _Number of baths -_ _ Lot size ----- r f l ____ Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table t. Character of soil to a depth of 3 feet: Sand ElGravel L] Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan E] . Previous Application Made: Yes El- No N.ew Construction: Yes I] No TYPE OF INSTALLATION AND SPECIFICATIONS: / (Nos ank or cesspool permitted if public sewer is available within 200 feet.) eprrrc 1 nk: Distance from nearest well—---------------Distance from foundation___________________Material----------------___-_--_-_--________..__________- -No. of compartments------ ------Size-------------------- ------Liquid depth------------- ------Capacity----------------------- f Friel Distance from nearest well----:`.:__=_.:..Distance from�foundati,on-----------_--------Distance to nearest lot line----------------- Number of lines--------------- ._.--------------Length of each line------------------------------Width of trench------------- ,------------------- Type of filter material________ _____ Depth of f" i terial____._______._._ _�otal length_______-________________--_______-_____-_ L t Seepage Pi : Distance to nearest well Q__...3_}__-_Dis c rom ou d ion__ _ _____ t cgeo nearest lot line_____________ Number of pits--_-I----------------Lining lm ria) p "�_ ze: Diameter Depth '�- r------- Cesspool: Distance from nearest well---------______._ om foundation____________________Lining material------------------------------_-____-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------.-gals. Privy: Distance from nearest well-------_------------------------------------------Distance from nearest building----------------------------------------- -------------------------------------------- . ❑ Distance to nearest lot line----- -- ---- -------------------------------------- --•----------- U10 Remodeling and/or repairing (describe): _�--_ ._ _ __ -_-�________________.__ ------------ �__ _�-Qom _ - ------------------ ---------- --------------------- ------------- -------------------------------------------•---------------------- -----------------------------------------------•-"------.------------------------------------------------------------•---•----------------- I hereby certify that I have prepared this application and that the work will be done in actor ce with San Joaquin County ordinances, State laws, and rulbsp�1&r� ns of the San Joaquin Local Health District. Septic Tank Service s (Signed)----- IZ06"5t�:�lYtarrc O---Ho-2-7846---------- -------- - ------- --------------------------- -- ------�er�f'Dr Contractor) or By: --- _. ------------Stocktonr,Calif.------------------------------ - - ------ - --------]------(Title)------ -------------------------------------- (Plot ------------------------------- --- (Plot plan, showing size of lot, location of system in relation to s, buildings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ----- ------ ---------------------------------------•----------- DATE------�-------- ----------------------------- REVIEWEDBY------ ----------------------------- ------------------- ----------- -------------------------------------------- DATE-------------I DATE = -BUILDING PERMIT ISSUED________________________ - --- ----- --- - --------- ------------•---"------------------------------ Alterations and/or recommendations:___.__.._I..---- - � ' �- .:: -- ---- --- ------------:-:.------------------------------------ " --- ` - - ------ - ------- -------------------------- ----------•---------------------------------------- FINAL INSPECTION BY:.---- --------------------------•---- Date---- --- ----------------------------------- 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 E5-9^2M 145446 ATWOOO 12-54