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APPLICATION FOR SANITATION PERMIT Permit No. _____7.ra�. (Complete in Duplicate) S Date Issued ------ Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and Inst H the work herein described. This application is made in compliance wi County Ordinanc No. 549. 1 `� .f JOB ADDRE55 AND*LOCATION-. fir _-- Owner's Name----- -- - - - -------- �— -.._ ------------------ ------- Phone---- • - - - - --- - Address --4. �-Epi` ----------- ----- Contractor's Name _ _fiWOr -? - -•-- -----•---------- -------•-------- Phone._/4--- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer o -t ❑ Motel ❑ Other [l r Number of living units:'-------- Number of bedrooms --------- s Number of bath ___ Lot size ___,�_ � ---------- _-_ - Water Supply: Public system E] Community system rivate [_1 Depth to ter Tablewleft. 4- Character of soil to a depth of 3 feet: fid ❑ Gravel ❑ Sandy Loam [� Clay Loam E] Clay ❑ Adobe❑ Hardpan '«r Previous Application Made: Yes No ❑ New Construction; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.)'. 4S- ic Tank: Distance from nearest well-----------------Distance from foundation-__________________ Material x,- No. ---4 of compartments------ --- ---------------Size--------------------------------Liquid depth------------ --------- Capacity Disposal-..F Id: Distance from nearest we04"__"_Distance from founclation-s-1--6.0------Distance to nearest lot line__._d ' Number of lines------4,f___ -.------ --. Length of each line----/-,r"_________,___...Width of trench_--* -. --- - dc- �''t- Type of filter material .&c- - __-_Depth of filter material------ ''._.__Total length-----Z_,CQ_--_.____________________ See a Pi . Distance to nearest well--J-0-V._-_---:Distant from foundation__�>�_-----Distance to nearest lot line__._-_ Number of its__ _s Linin material _ _ ..`�� 0"� _Size:;diameter___ Depth p �`------- - g ----- De to--- - ------------- Ce spool: Distance from nearest well-----------------Distance from foundation------------_-------Lining material------------------------------------- ❑ Size: Diameter-------------- •---------- 4'---Depth--------------" ----------------- Liquid Ca acit Y------- -------------•--_--gals. Privy: Distance from nearest „ ___________ -----------------:___._bistance from nearesr building Distance to nearest lot Brie_'-} ............................. _ ------------------------------------------------------------------------ ' r Remodeling and/or repairing (describe):-- '~=---------- --------- r-- .j, k------------------------------- ------------------------------------------------------------ --------------- ----------••---••----------------------------------'•---•----•----------------------•------------ ------------------------------------------•------••---•------------------- -------- --------------••----------•---------------------------------- ---------------•------------•------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r s of the San Joaquin Local Health District. DAY & WIT (Signed)_ Septic Tank Service 1 . f ��So. ElcTorado KG-2;7C[46-------- --�wMW_:W*or Contractor) BY: StackinnF_iiwc�lif. - �- --------- ---- --- (Title) �� (Plot plan, showing size of lot, location of system in relation wells, buildings, e4 can.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY= - F ------- DATE__.. ------------------------------------------- ` REVIEWED BY------------------------------- DATE----!" "e------------•--------------• i - - ----------- BUILDING PERMIT ISSIJED-------•---__ZZ-J__'N-------------------------------= ---------- DATE------ V ------------------------------- - Alterations and/or recommendations:....___._____._..._____...._.____.. , ” ------------------------------�`' --------------------------------- -------------'--- -- ------------------------------------------------ -------------------------------------------•- --------------------- --------------------------------I--------- -------------------------------------------- .........tL--------------- ----------------- ------------- -------- ' ------- ------------------------------•---------------------------------------------------------------------------------------- - ------------------- FINAL INSPECTION BY: •- -- -- - -.. ..................... -- -----... . Qate. 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 w ES-9-2M 145446 ATWOOO 12-54 i