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APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) Date Issued _r1/}7 Aa. Applica-6ion 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 comp lance with County Ordinance No. 549. ---------------------•-------- •---/--------- JOB ADDRESS AND LOCATION ------ �T Owner's Name.--. { � ` Phone. -- - •-------- ---- ------- --------- ----------- Acid ---- Acidressa ------Y1.2-K-L_10----- -r--------•--------------------------- ------•-�---------------- Contractor's Name--- `t'-I�-��.c-�-[�-i'-----�-��c------. fir--=- Phon--------------------•--------------------••- •-- .-i1r'l.'-. 7�---A..----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ { Number of living units: j-_.- Number of bedrooms --"Number of baths .--1-- Lot size -_--.--_-.---._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to'a depth of 3 fee+: Sand ❑ Gravel g-"Sancly Loam ❑ Clay.Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or.cesspool permitted if pub is s wer is available within 200 fee_W", p is nk: Distance from nearest web-A50-----_Dista c `�o fo Pndation_f- -------------Mater al-----_---.--.--.--.---_-.------- Liquid depth. - p Y Set No. of compartments....�1�_- -- --------Size' '� ---- _Ca aut --�----_----- In g ---------- Disposal Field: Distance from nearest well-14-10----Distance from foundation--- �...e. ,Distance to nearest lot line-----10 ----- Length of each line----- --- 4-0-- Width of trench.-�-X`.................... Number of lines----- --•------ Type of filter material- _L4+Nf---_Depth of filter materiaL___1(f -.-.-_Total length__" - - ----------- Seepage Pit: Distance to nearest well/r�0---------Distanc rom foundation--- -_ ---� s knee to nearest lot line--/ Number of pits-----l- _----------Lining material ------- - -.___----.-Size: Diameter---------------Depth---6. -_--- Cesspool: Distance from nearest well-------_-.------Distance from foundation------------------- Lining material------ .�------.--._----_. `pg ❑ Size: Diameter--------------------------------------Depth-------------------------------------------- ----Liquid Capacity------------ --------------gals. 1` Privy: Distance from nearest well---------------'_.-____---.----.._---------....-Distance from-nearest building."-:_- ----- "-� ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------- -----------------------------------•-•-••-•----•------------•--•--------------------------• .-•-•----------------- -----------------------•---------------.-...--•----•-----------------------....---------------------------•-----------•--•-----------------------------------------------------------------....------------------------------- r ---------=----------—---------- --------------------—---P------------------PP---------------•-------------------------• --------------------------•----------•-------------- ------- I herebycertifythat I have prepared this application an at the work will be done in accordance with San Joaquin County, ordinances. State laws, and rules aanddt egulafl ns of the San oa uin Local H Ith District.DAY FGHT Septic lank Service (Signed).... u.,.. . .= -p-------------- ------- ------ ---- --- ----- ------ ••-- --- r Contractor) - 206 So.Eldorado HO 1 704f� - Sy:r_.. _- Str4st °€F ------ ---------- ------- --- ------------- -{Title '-- -= (Plot plan. showing size of lot, location of system in re do o wells, buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------- - - ---- ---- ------- ----------------•--•-------------------- DATE------------ ,a.- ---------- - REVIEWEDBY ---------------- --------------------- ----- ------------------------- DATE-------------------------------------- ------ BUILDINGPERMIT ISSUED-----------------------------)------------------------------------------------------ ------ DATE------------_-----• --------------------------------------- Alterationsand/or recommendations---- ------------------------- ----------------------------------------------•--•••-----------••--------•--------_._.-...--•---•-----------••---•-------------- --------------------------------------------------------------------------------------------------- ------- ------.--------------------------------•------------------------------------------------------- --•-------- ------------ ----------•--------------- - ----- ----------------•-----•---- -- -------- ------ ------ ---------- �} ------------------ - -- --------- -• ---------------------------- --------------- FINAL ---- ------- -----FINAL INSPECTION •BY------------------- ---- ------------- . Date.------------------, ---------------------------- ----------•---- 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 E5---9 14544r ATWOOD