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\N4It Y APPLICATION FOR SANITATION PERMIT Permit No. ___75........... l' r (Complete in Duplicate).. - /Y-1/1� Date Issued ___ _____________ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to.construct and install+he work herein: described. This applica+ion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONZ_�'" .g---- - +Pi '---------•---------------------------------------------------------------- Owner's Name. ;---------' f Phone Address------------ 1-4-4-710- ------ = {----- ------ ---- .--------------------------------------------------------- ----- ------------------------ ------------ --_/ ----------- Contractor's Name-------------------- -- 1 � Phone__ y A� Installation will serve: Residence .,.partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:I_.____ Numbe euro"oms __umber of baths --_I_: Lot size ____-� ._r- ----------- ---•- Water Supply: Public system ommuriity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ElGravel M Sandy Loam ❑ Clay Loam K}—Clay ❑ Adobe ❑ Hardpan 13 Previous Application Made: Yesi-15-0—E-1 New Construction: Yes 0__wo ❑4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septi Tan : - Distance from nearest well_________________Distance from foundation_ -_----____-_____.Materiai--.______--_-__-__________________-_______-__--_� L� R No. of compartments------------.--/-----------Size-- ---------Liquid depth--------------------------Capacity---------�j Disposal eld: Distance from nearest well-_11fQ �_Distance from foundati _.____-.Qistance to nearest lot link________________ Width of-trench---._'� Number of lines-----------/--�-.__ ---�-ffx---Length of each line-._-- --- p-------------------- ' Type of filter material_,C._!_t-_ —,.-Depth of filter material..- _____. Total length ------------- Seepage Pit: Distance to nearest well----------------'____Distance from foundation_____ _____--------Distance to nearest lot line-------.--------- ❑ Number of pits----------------------Lining material---------- -------- Diameter------------------------Depth--------------------------------- Cesspool: F vy Distance from nearest well________________ Distance from foundations-- ---------Lining material__-____---_________-_________-___-__. ❑ Size:•,Diameter------------------------------ ------ Depth--------------------------------- °-----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----- -------------------------------------------Distance from nearest building-----------__----------------------- --- ❑ ` Distance to nearest lot line-------------------�._.____ Y k ---- Remodeling and/or r~ airing de cribe) R ---------------- ----* ----` -------- ------- -y-•--------------- __14 Al ' IM ------------ == - r - ---- --- _. --------- --------------- -x - -----•---------------------------------------=------------------- --------------------------------------------•- -------------- ! hereb certify tha+ I have prpared this app ication 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 & NIGFdt - --------- ----------- ------ heA�an�d/o,.r..C�onfractor) Si ned --- ---------Se ic-Tanis--Service-------- ------ -- - --------- ( g ) 1206 So. Eldorado HO 2-704 Y= � -- --- zt, tle}-------- S R -n i'ssTe1F (Plot plan, showing size of lot, location orsystein in relation to wells, buil gs, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------- - ------------ -- - -- -- ------ -- ---------------------------------------- DATE------------- -- �• -- �"' REVIEWED BY------- -------=--------- - ------------------- DATE- v=__- BUILDINGPERMIT ISSUED------------------------------------ -----------------------------•---•----------------------- ---- DATE-------------..--------------------------------------------- Alterations and/or recommendations----------------- ------- ------------- ---•-------•--•------------•-------------•----------------•------•---••-----•-••-----------------•------------ ---•----------------------------- ----------------- ----- ------ - ------------------------- 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 EE___9_2M 145446 ATWOOD 12-54