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1 \41 APPLICATION, FOR SANITATION PERMIT Permit No. ... _(Complete in Duplicate) Date Issued ---- A �plica4-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 Ordina e No, 59. k- JOB,AIDDRESS AND LOCAT-KK---- ------ ------ 5q� - ---_------------------------ ---- -- Owner's Name-------•-----_--_--- .......... --- --------- -- - -------------------------------....... Phone--------------------------------..J - ------------ . .......... Address--------------------- --------- ----- ---------- - -- ----- ------ ............... ------------ Contractor's Name---------- .. .... -- ---- L ----------------- Phone- -------- - - -, - 4-S&------ ---- -- --- ---- ------- Installation will serve: Residen &--ApartAnt House-FE] ornmercial F] Trailer Court, 0 Motel E] Other E] Number of living units: _�Number of bedrooms Number of baths .1---- Lot size ----- Water Supply: Public system --------------------- Comm6nify system El Private R Depth to Table -------� ft. Character of soil to a depth of 3 feet: Sand E] Grave; E] Sandy Loom E] Clay Loam E] Clay ❑ Adobe El--l-lardpan C] Previous Application Made: Yes ET-'Ko El New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) oe opup dation-- -_._-._.-/ Septic Tank: Distance from nearest wel ----Distancpjircin f70 Material - e-Z-c No. of compartments_________ Size_,r_'W__�e _77__-.-Liquicl depth_.-__ .4�- -------._Capa6tY--7�1' Disposal Field: Distance from nearest well �Distance from foundafion_,,4-Q1_F"V...... istance to nearest lot line________ ------ Number of lines___:__-____12-—-------- --Length of each line- 6T ' ��iclfh of french---------;3,O_ ------------ Type of filter materi.aI__1`r)e-A-,._j)epth of filter material-_ ---- ------------Total length--------- --------- Seepage Pit: Distance to nearest well...0.2161A-_ -Distance from foundafion_____75_47;_Di4ance to nearest lot line-14r- Number of pits _Y: -------Lining maferial_P�2_,C.A6 Size: Diameter.------I---(--"--.Depth-------->-4-----------I------ Cesspool: Distance from nearest wel-----------------Distance from foundation--------------------Lining material----------------- - ------------------ El Size: Diameter------------------ --------- .....-Depfk------------------------------------z---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------__----------Distance from nearest building------------------------------------------ ElDistance to nearest lot-line- ------- ------- ---------------------------------------------------------------------------------------------6 Remodeling and/or repairing (describe):------------------ ----------------------------------------------------------------------------- --------------------------------- ................ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------w------------------------------------------------------------ 7 A I ----------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, and ruleDAY &4410§A of the San Joaquin Local Health District. Septic Tank Service 1206 So. Eldorado HO-2--7-046 -------------- ------ -(Owner and/or Contractor) Sy:------------------------------------------------------ -------- -- ---- --------------------------------- (Signed)---------9--------------------- Calif. 4 -�9 -------- - plan, showing size of lot, location of system in relation to wells, buildings, etc., caii-ba '111aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE5' ;n----------------- --------------------------------- REVIEWED BY------------------------------- -- ----- - DATE----,-7---------- ]� -------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------9^•------------------------------------------------ Alterations and/or recommendations:------ -------_---------------------------------------- � `-)-•-----•--------•----------------•--•-•-------- f= F_ I----------------------------------------------- -------------------- -------- --------------------------11---------------------------------- --- -- -------- ........... .................... ------ ----- - 1 Z---- - ------- ------------------------------------- ---------- -------------------------- ----- - --- --- ----- --------- ...... ------------------------------------ ------- - --- -- ---- -------- --------------------------------------------------------------------- - --------------------------------_----- ------------- .................. ------------------------------------------------ ----- ....... ------------ ----------------------------------------------- I------------------------------------------------------------------------- ---------- --- ------------ FINAL INSPECTION ............. .... --------- -------------------------- Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lott', California Manteca, California Tracy, California EM-9-2M 145446 ATWOOD 12-54