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CWIPLICATION <br /> FOR SANITATIO ermit No. .......0 •_I _ <br /> (Complete in Duplicate) <br /> Date issued <br /> Applica+ion is hereby made to the San Joaquin Local.Health District for a permit to construct and install the work herein described. <br /> This application is made in co pliance with County Ordinance '549. w, <br /> JOB ADDRESS AND LO IQ <br /> .............................. <br /> Owner's Name. -• --•-•-. = ' <br /> • _:_zc'- Lam:------ --- --------------------------------------- Phone----- ---- <br /> Address................ <br /> - <br /> ----------------•------------------------ <br /> Con}rector's Name. �' c, <br /> " _ Phone <br /> Installation will serve: Residence A artment House!�•-•Com - ----•---- .•-------------•• -------•------=•_-•- <br /> mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: �____ Number of bedrooms _umber of baths ../-_ Lot size ._ <br /> Water Supply: Public system 2--community system ❑ Private Depth to Water Table -Irvft. / <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay.Loam ❑ Clay❑ Adobe glo ardpan ElPrevious Application Made: Yes E] Noew Construction: Yes ElNoI i I _� <br /> TYP OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 6ep Distance from nearest well_________________Distance from foundation---------------------Material____________-._______-_____._--___________._-_ _- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity_ <br /> al FiQld: Distance from nearest well________ ______Distance from foundation_____...__________-.Distance to nearest lot line................. <br /> al <br /> . `� Number of lines-----------------------------------Length of each line------_------------------_Width of french------••----_-------_---_ <br /> Type of filter material___.-----. _Depth of Wer material_____________________ �tal length-------------------------_--___-_--------- <br /> Seepage Pit- Distance to neares well_-/ _._Distance fr m fo ndation____/Wit_.___p' . cVo nearest lot line__. .__ _ <br /> /D <br /> [ r Number of pits----___________-----Lining material--- � _-Size: Diameter..__ -__--___De }h__. ` <br /> p *�'' <br /> Cesspool: Distance from nearest well_________________Distance fromp <br /> foundation----------•--------Lining material----_------- ----------------. <br /> ❑ Diameter <br /> Size: Diameter-------------- ----------------------Depth- De <br /> p p --------------------------------------------Liquid Capacity------------------------..--gals. �" I <br /> Priv r _ _ _ <br /> Distance from nearest well- ___-.__- _ _________________________________Distance from nearest bui!ding___ -_____.._______.-____ <br /> El Distance to nearest lot line <br /> Remodeling and/or repairing (describe)--------------•-•-----•---------------_1_._1--------------------------------------------------- <br /> -•: ----------------- ------•------------••------•----------•----•------•---------1----------- <br /> - --•---- ------- - --- -•--------- - P - - ----------------------------------------------------. -------------------------•-•-------------------•-----------------------•----------------------- <br /> I herebycertify <br /> that I have prepared this application and fhat'the work will be done in accordance with San Joaquin County <br /> ordinances, State , and rules i0jk�e&u�1of the San Joaquin Local Health District. <br /> (Signed), <br /> B ;----- == -----------------------------------------------------------Stockton, Califs 1 - .Ai �/,or-Contractor) <br /> I2 -So.Eldorado---140-2-74"6---- ----- L__ <br /> Septic an Service <br /> Plot Ian, showing size of lot, location of system in relation fa wells--------------------• ---------(rifle)----------��'� <br /> . <br /> ( P 9 y � buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY. ' <br /> APPLICATION ACCEPTED BY---- ---------------------- ----- --- ----------------------------------------------------•---- DATE----- <br /> REVIEWED BY - <br /> ------------------ DATE-------•----------_. -----•--------------- - ------- <br /> � <br /> BUILDING PERMIT ISSUED ------------------------- DATE----- --- - <br /> Alterations and/or recommendations:----------- ------ ---- -- ---------=----------------------------------- <br /> -------------------------------- ------ --------- <br /> ,� ,.:• '" <br /> -------------- ------ --------------------••--•----------------•-•-•-•--------------------------- <br /> -----•------... - ------------------------- --•------_--------------- ---------------------------•-•-----------------------•--------------------•------------- -- <br /> -- •--•----.---•---------•--------------------------------••---- ---------------------------- ------------------_------------------------------------------------------- ---•--•-------------------------------•-------- <br /> FINAL INSPECTION BY=------ ---- - - �------- ----•-----------•-- - --------- Date-----------e---­ <br /> SAN JOAQUIN LOCAL,HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street j <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> i4 <br /> ES-9 145446 ATWOOD - I1 <br />