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APPLICATION FOR SANITATION PERMIT Permit No. -.-7---3.1.3„ (Complete in Duplicafe) Date issued Applies+ion is hereby made'to the San Joaquin Local Health District for a permit construe and install the work Qherein described. This application• is made in compliance with County Ordinance No. 549. ,A). JOB ADDRESS AND OCAT N..-_. R. - ; ..- .... ....... Owner's Name........... ' . ........... Phone ,e.............c ....... ,.L7�,_ ._�"`,r? �,... ----•--------------- Contractor's Name..._ .! .F ` �- / • .. �.. ... _...................................... ............. ......... Phone. .. Installation will serve: Residence [Apartment Mouse ❑--�� Commercial [3 Trailer Court E] Motel E] Other F 'Number of living units: -___'Number of bedrooms,•,7____ Number of baths /ttot size .... - .w .............................................. Water Supplyi Public system'D Community system ❑ Private 2r';6`epth to Water Table ft. . Sand Character of soil to a depth of 3 feet: Gravel- ❑ Sandy Loam❑ Clay Pmjn p Clay❑ Adobe[r'F ardpan❑ Previous Application Made: Yes ❑ No ff New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 'INa sepfic fank�oorYcesspool'permitted if public sewer is available within 200 feet.) S T c Distance from nearest well..:..............Distance from foundation...................Matetial.........._..._.__...___.._....__ .. ....._.-•------ ,No of compartments..........................Size--------------------------------Liquid depth__---_-._....-------__._..Capacity osaLjield: Distance from nearest well.................Disfarce from foundation....................Distance to nearest lot line................. ! Number of.lines__ ..........`.....Length of each line..............................Width of trench..............-.................... Type.of filter material.............._........Depth of filter Material.....-_.....__...(.Total length.............. ......--•------•--•-•-----•• Seepage' err: LOV Distance to nearest well_�i ...........Distanc rom undation--_?...i._.. ._..Dist i� to nearest IQt iin ._. .....� fl i� S� Number of pits---- --------- Lining material..6�--...Size: Diameter. -----..._Depth. ---------------- Cesspool: Distance from nearest well.................Distance from foundation...._.............. Lining❑ material.Diameter............................. _._____...._..___..........__._..... Depth ....................Li Liquid Capacity ---..gals. Privy:; Distance from nearest well.................................................Distance from nearest building...................................... ❑ Distance to nearest lot line--. Remodeling and/or repairing (describe):................. ....... ...........--..............................••--------------•----•-----------•------------. •-----.---- - s ..................................---------•----------•--•--------.......--•-•---•..........................................._._.._. ....... ................................I.............................................---•---...------------------•--------•------------•-••-•------------...............................................................Fhereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and•regulations of the San Joaquin Local Health District, DAY&ALIGHT (Signed)..... ---------------Septic.Talc_Servim----- ---------••---. . ----•--- I Contractor 1206 So.Eldorado HO 2-7046 i By:. Steshiioa; Calif: (rifle) ----...__. (Piot plan, showing size of lot, location of system in relatio o wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYk,N ..-- DATE ....................... -------_-•-- .................. ......... BY.. - - -------------------------•............--••------- -------------•---•-------• DATE_. ._... --_---------•------•--•------ BUILDING PERMIT ISSUED........................ --._._ ........................................... DATE......_ Alterafions and/or recommendations:--:............................. ......... �"' ---------------**------- ------•--••------------ .....................I..........................................:_..................................... . ......... .............................. ............ --------------------------------- --------------------- -----•----•----.-•............... .......---------------------------- F •----- FINAL INSPECTION BY:.:::...... ..... ..-- ....... Date.-----..._..........--. ---.. �" 1Y 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-�yM 345446 ATWOOD 12-54