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APPLICATION FOR SANITATION PERMIT Permit No. .Jl _7_.... (Complete in Duplicate) f/y / )]ate Issued --- Applica-ion 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION j' ----------------- -- Owner's Name-------- - ry e`----- ---------- -- - ----------------------- Phone------------------------------- Address.... --------------------------._..Address---------------------------- ---------- f. // -------------•---•-�------------------�-----------------....----------------------------------------- ----- =--------------- Contractor's Name----------------- �f_ C1[:�-__c�_ c----- ----------------- ------ Phone_-1�7�_! _�1_I � Installation will serve: Residence RKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.!__ Number of bedrooms Number of baths _l____ Lot size ___- _ - _:------_ -_ -----_--_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ ' # TYPE OF INSTALLATION AND SPECIFICATIONS: 7 W o septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Distance from nearest well ______________Distance from foundation__.__________.___Material------------------------------------- i al Fi el 4aof compartmentsSize Liquid de th-- --------------------- No. Capacity ' ce from nearest weil_��04.=-Distance from founc#ation__.__ _.. .__._.Drstance to nearest lot line__Aa.L.... Number of lines-___�___ _._ -----Length of each line--- of trench___. __ L__'f___-__________� Type of filter material __ Depth of filter material-_-- ` __._____Total length----- ---�`' ___________________� epageP' .� Distance to nearest well--Al ____Distantdr,", m foundation___ __..__.Size: Diamete'- - to nearest lot line.._ _ ._. /� Number of pits------ ----------Lining material_ • -.D=sta ce Depth_.___. __- Cess Distance from nearest we]-----------------Distance from foundation--------------------Lining � material-------------------------------------- Ll ____ _______________________________ ❑ Size: Diameter--------------------------- ----r----De Depth--- --------------•-----•---------- -------------Li Liquid Capacity--:, -- --------gals. i Priv Distance from nearest well____. , ____Distance from nearest building Y "' = g----- ------------------------------------ ❑ Distance to nearest lot line.-,-- -- ------------------------------------------------------------ - -. Remodeling and/or repairing (describe)---- -------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------•--------------------------------•----J---• ----------------- -------------------- --------------------------•-----------------=---------•--------------•--------------------------------•----.----------------------------•----------- -----------------------------..-------------------- ------•----------------------•----------------- ---------------•----------------------------.....•----•------------------••-------------------------------------------------------------------------1___1------------------- I ---------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rV�sT ions of the.San Joaquin Local Health District., 0- - .................. Septic Tarek Servicer -(Signed)--- ) i6 Sb:f1i#era�da -44t3 7fl46------- -- BY - �`t�4Jklo�r�-Ccsl)f-------- -------- ----- .---- - --------- (Title) ---- Contractor) (Plot plan, showing size of lot, location of system 1n rel n to wells, builds S, etc., can be placed on reverse side). � i FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- ------ ----------------------------------- DATE---------------------- -------------------r REVIEWED BY >... . - DATE ..r - -- ------------------- ------------- ----=---------------------------------- BUILDING PERMIT ISSUED--------------- ----------------------s------- -------------------------------------------- ------ DATE.--- ---------------- - ----------------------...---------- Alterations and/or recommendations: t =' ----------------------------------------------------------•-----•--- -•--------------------------------•--•-------------------- ------------------------------------------------------------------------ --- ----------- ---------------------------------------------------------------------------------------------------------------••-•-•--•----------- ------------------ •------ ---------•----------------- ------------------------------------------------------•-•---•----------------------------------------------------------------------------------------------- - ---------------- ------------------------------------- ---- ---- - ---- . ---- ------- -------------------------------------------•-------------------------------------------------------------- a FINAL INSPECTION BY:- 00 -- Date 11�� ----------------------------------- - 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---9-2M 145446 ATWOOD 12.54