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` I d APPLICATION FOR SANITATION PERMIT Permit No.er .__ _ 7r1-.. (Complete in Duplicate) / Date Issued 0-51 - 140-14(� jAplica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and instaff the woo k herein described. This application is made in compliance with County Ordinana � 3 �� "wtf� I'�e2►d 1{ 90314 S'0.&7`x 4 i'i°s`(� ey+� /C�� ah fv O.0 T &i'd e .� JOB ADDRESS AND LOCATION.. e .____ C'��►t�,s9o�vrT/'� f- --�--------••---- --------------••-------------------------------- Owner's Name------------- �i9_t?7-—V---------- r ' I�� "1 ''�' '-/Vt Phone------------------------------------ Address /Lf' * _.. Nd•----- --. �'�S >. ��J ----------------------------------------o - Contractor's ---------------------•------------- c� Contractor's Name------- a—x---- ------ ------- r YG ------------------- ------------ Phone? .AZ.$o4-b_.. Installation will serve: Residence [Apartment House ❑ Commercial [I Trailer Court ❑ Motel F1 Other L)Number of living units: ____1_/_ Number of bedrooms __',Number of baths _Y_ Lot size --- -------•------•- Water Supply: Public system [] Community system ❑ Private Z--15epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ,Sandy Loam lay Loam [] Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if�lic sewer is available within 200 feet.) ^ � v Septic Tan Distance from nearest wrell _--�. _-__Distance from foundation:f_____._z-_--Material_- __. ------------ L� No. of compartments____ __________________Size__°-_7S__ __.Liquid depth_.........._--Capacity- -_-__-__ Disposal Field: Distance from nearest well_ ----'Distance from foundation__,_'' Distance to nearest lot line__ _"--__ Number of lines.-___. ___---- -------Length of each line_ _0_--'_._.__-..-._.Width of french.... �-��'---------------- Type of filler material-_ .: r-.-Depth of filter material__ 1.7-_-___wTotal length___.�V__�_______________________ A �+ � s N Seepage it: Distance to nearest weff_/W.------Distant from foundation__-r_______,,D��is//tante to nearest lot line------ of pits-----/-----_______-Lining mater'—L"--------- - - ---------Size: Diameter._ `�___-.Depth-...2D'----- _----_ Cesspool: Distance from nearest well-----------------Distance from,foundation._..;:_..._._-----_Lining material__.__________._______________--_I ❑ Size: Diameter------------- ------------------- ----Depth------------------------------------------- --------Liquid Capacity-.--------------------------gal Privy: Distance from nearest well-----_________________-....____--_._--____-..__Distance from nearest building------.______._____-__________----------- El ____ - ❑ Distance to nearest lot line. -- Remodeling and/or repairing (describe)--------------------------------------------------------...--------------------------••---------------•--•-----•-----•------------- -----------------------------•-•-------------------- •-----••------------•-------------------•- --------------------------------------------•---•----------------•-------------------•----•-------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countunt ordinances, 5t laws, and ru�sA�c�rm }' ns of the San Joaquin Local Health District. (Signed)---- Septic tank Service ---- -- - - - ------------ ----------- or-----T2�So:lWtdarada---ii0-2�7046- -------- ------ - [�/ Contracto By: .................. Calif.-------- ------------ - {Ti+le) (Plot plan. showing size of lot, location of system in relation to, ells, buildings, c., can be placed on reverse side). FOR DEPARTMENTU- SE USE ONLY APPLICATION ACCEPTED BY. ---. - - DATE_ --------------------------------- REVIEWED BY-------------------------------- - -• DATE BUILDINGPERMIT ISSUED------------------------------------------------------ -------•--------------------------------------- DATE------- ----------------------------------------------•- Alterations and/or recommendations_______________ ________ __ fr------------ -------------------------------« ------------ ---(--_-y- -------------- --- ----- . -------------------------- ------------------------------------------------- ------------- ----------------------------•----••----•-•--•--- .:_. ____.-._� ..._. '___---+ -- � (__r. ti'�eL�r`c B. w a, /� ♦; r - ---1�-"�r`-' �-- 1•'t�z�e�G�---�,�t,SfL�tt./afeaxz� 4�,�x�'---��l.�C�.�•xr� Tl.`� A-X91-----------------•----- ----------------------------------------- FINAL ----- -----•---------------FINAL INSPECTION BYE f; 1, -------------------- Date--- SAN ate--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-9-21A 145446 ATWOOD 12-54 A