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v._ T Permit No. APPLICATION FOR SANITATION PERMI '__.7_ `7. _.. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San aquin Local ealth DistrictLapermit t construct install a work herein d s rib�d. This application is made in compliance ith County O anee No. 5e JOB ADDRESS AND LOCATION 4 ------------------ ---- -- -------------- ------ - ---------- -------------- Owner's Name----------------- - ----s1-i ------ Phone.................................... Address------�'�' !--1�:Q. - '+!-lam."- („ a-I --------------------------------------• w Contractor's Name---zvy_`� _ .;.qh4-�-------,�t�_.. �C._, ------------------------------------------ Phone.--- -- -=• Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -.1--- Number of bedrooms -./-. Number of baths .4 Lot size ---- ._____.JK-_8'.,1`x__________________ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table OzQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff-.-H'ardpan [ � Previous Application Made: Yes ❑ No ®/flew Construction: Yes ff-'No ❑ p ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well,c�_ ___Distance from foundation._�jO-�_--.Materi lb____________________________ -------------- '10 No. of compartments---2--'.____-_.___.._Siz� _ �_.��.__Liquid depth__� _.-_._..__Capacity___,1.�r!�_ �vr � ..Distance to nearest lot line... Disposal Field: Distance from nearest well.....Distance From foundation__.r.,�...... . Number of lines...... _..___.. ._. Length of each line- __p_ �T` Width of trench. .-. Type of filter material_ _ __.0 _ .__ Depth of filter material...._�Q__r�_.._.Total length./_ -L�_�_.4�!�'�- `4`1 See P' Distance to nearest well-----_----------------Distance from foundation....................Distance to nearest-17o ine------------------ 4�e� - Number of pits----------------------Lining material-----------------------Size: Diameter---------.---..-------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.__.--_-_--.___.Lining material-------------_-------_-_-__--_--___-_. ❑ Size: Diameter------ --------•--- •-- .......Depth....................................................Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.-____-__-__.---_---_----____.---__-----. ❑ 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 County ordinances, laws, and ru6s.& ons-of the San Joaquin Local Health District. UAYMOW (Signed)__.. Septic Tank Service � Contractor) ---1206 So.Vdaradt►--INQ44 �6i--------------- - --- By� ----------------1t9c S f ................ (Title) We f1 ej----------------------------------------- (Plot plan, showing size of lot, location of system in relation to Ils, buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ------- ----- -------- --------------------------- - DATE---------------------------------- REVIEWED BY .;;..-• ....-- - DATE..--- - g<.• ►�Q VQ, BUILDING PERMIT ISSUED. DATE ``'............... Alterations and/or recommendations----------------------- ---------------------- -------------------------------•------------------------------------------------------------------ ----------------------------------------------------------------------------- --- ------- ----- --- ---------------------------------------------------------------------------------------------------------------- .........................•---.------------ -------------------------------- . -- --- • • . ------------- ------------------......--------•-------------------------..........------......----•--------------- FINAL INSPECTION BY: Date /-- --------- ----------------------------------- AN 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 E5-9-2M 145446 ATWOOD 12-54