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L-a 0S APPLICATION FOR SANITATION PERMIT Permit No. __.7. !.... (Complete in Duplicate) Date Issued __ I Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install t�work herein described. This application is made in compliance with County Ordina/n�ce� No. 549. K Q�y,o o.` C9. JOB ADDRESS AND OCATION......... /5-cry------------ ___ • Owner's Name-------- •-= . ----••--••-•--•-•------------- ------- e� ------ Phone-TE .Z946 ...... Address.......................... ---•--------------•----------------- Contractor's Name.. L �4,4A-�------- :----t--+-• 1�C,,.----------------------------------------- Phone-o*-A_71J--,�''---�--- Installation will serve: Residence Apartment House ❑ eN mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---__.. mber of bedrooms ----- umberof baths/_____ Lot size _____Is _V 7�.___ 1. .� ------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table j ft. Character of soil to a depth of 3 feet: Sand ❑ ,Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [_'_ Previous Application Made: Yes ❑ No �ew Construction: Yes k-<o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest well_21-------Distance from foundation----�o_�_____.Materia_-___________________________�_._.______- .... No. of compartments--I__-_._____._.-_Size_ __......3___. .Liquid de th_.,, �'__.-___-__._Ca aci — q R Capacity-- sal � 6 3 N c��p , g . Dis osal ield: Distance from near st well_J6e__-______Distance from founds 'on__._ Distance to nearest lot line... ._._ _. Number of lines_________ Length of each line_' ' _.,.Width of trench___.. a ••-- Type of filter material_ Depth of filter material____- _ _ !_____.Total length___.__ _,113 ......... Seepage Pit: Distance to nearest well_�89-_____Distance from foundation__j.0'_____.Distance to nearest lot l' ........ Number of pits---(-----------.-----Lining material._dUU-S--------Size: Diameter__-_-_ Depth-- Cesspool: epth_Cesspool: Distance from nearest well----------------- from foundation------------------..Lining material------_.-__1.7"':............... ❑ Size: Diameter--------------------------------------Depth-------- ----------•--------• ----------------------Liquid Capacity-----•-•- •--•------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ F1Distance 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 County ordinances, State laws, and rules and regulations of the San aquin Local Health District. DAY& NIGHT (Signed)-- SePtic-Tants-Setvioe- ---- - ------ .- -------------- -- ----•--- -••----- ------- (�r Contractor) \d - 1206 So.Eldorado HO 2-7046 -rt -------Title___B . �firi; -- ----- - ------------------- (Plot plan, showing size of lot, locat,on o s Siem in relation wells, buildingscan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------------------------------- ---•---------•--••-----•-•--- DATE----------------- •- ----------------------------- REVIEWEDBY----------------------------------------------------- ------------- ---------------_ .................... DATE------CVS-y.......................................... BUILDING PERMIT ISSUED--------------------------------------------------- - ........................... DATE.......................................................... .. Alterations and/or recommendations--------------------------------------- --------•-•••---•--••--------•------------•--••---•----••------••--•----------•=--•-------•---•---•--------•---•••••- 011' _��; Z FINAL INSPECTION BY:----------- Date------ --------,aa 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-9-2M 145446 ATWOOD 12-54