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- -=-�`y�i• 3 APPLICATION FOR SANITATION PERMIT Permit No. "'°7 -" - �-t, (Complete in Duplicate) Date Issued � b made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+'ion is hereby This application is made in compliance with County Ordinance No. 549. --- JOB ADDRESS AND LOCATION..- ----- ----- ------ ------------------------------------------ Phone----------------------------------- Owner's Name------------ ----------------- - - ------- -----••- - - •-f! -- -- ---- - -------- ------------------------ -----------------•----------•------------------- Address--------•-------•-•-------•---------- • ... `� ..'. Contractor's Name cL� L - ?�-�`-o=t! 7�----- ` .'"'-. : Installation will serve: Residence <[Apartment House El Commercial E] Trailer` Court t] Motel ❑ Other ❑ Number of living units: _._ mber of bedrooms mber of baths ___�__ Lot size ___ �_-'--- ---�•• f Community system ❑ Private Cl- Depth to Water Table _ elft. Water Supply: Public system Character of soil to a'depKof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well..:.___----A-__Distance from foundation__-__----__-----.Material--_-___----------------------"-_-__.__-.------- Se --Liquid depth--------- --------------- Capacity-------------------- �,= No. of compartments------- ---- ---- ----=--Size-,------•--------- ----------- -- D' sa F' Distance from nearest wel Distance from founclati - ion. --.--.Distance to nearest lot line____ t ,� Number of lines-�---- ------Length of each line-------------------------- Width of trench.---------------------------- �" Type of filter material____. -� Depth of filter material-----------------------Total length--------------------•------- = Distance om oundation__ `____..Distance to nearest lot line Seepage t: Distance to nearest wel _ __ . _ ._ p ;. Number of pits...-_r__---_ '^""Ling material_ Size: Diameter.---ff ------- Deptn_., -�----------------- �n Cesspool: Distance from nearest well--_-_-.--___-._-Distance from foundation"__________________Lining material.. __--_______ --De -th--- ------- -----------= ---------------------Liquid Capacity,_-------------- gals. \-Z' ❑ Size: Diameter---- ---- --------- ---- ----- - P Privy: Distance from nearest well-------------------------- -- -:----Distance from nearest building------------------------------------------ Privy- Distance to nearest lot line-___-_.---"--__.---- _ ------------- Remodeling and/or repairing (describe):-------- ---------_----------------------------------------------------------------------------------------------------•---------------••------•--------- - _ ---------------------------------------------------------------------------------------------------------------------------------- I - -----------------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. Joaquin Local -Health District. DAY cr NiGHT --- r Contractor] Si ned -_Septic-Tank--S^rvice----------------- --- --- ---------- ------- - ------------------- /-47Z( 9 Tale -_1206 So. Eldorado k0 2-7046__---_..---_"-- B ----- � (Plot plan, showing size of lot, IocationTo�'sysserih in relafion ells, buildings, et , can be placed on reverse side). FOR DEWTMENT USE ONLY 4 - APPLICATION ACCEPTED BY. -- ------------------------------------- ----••------------ DATE-RA --------------- ---------------------------------- DATE----=�..---------•-----------------•------------------- REVIEWEDBY--------------------------------- ---- --------- ------------------------ ------------------------------------------------ DATE .... --------•-------------------------- -- BUILDING PERMIT ISSUED---------- - -------------- -------------------------- • Alterations and/or recommendations:----------------------------------- ---------=......•---------- -------------------------------------------------------------------------------------- - -------------- ---------- ------ �.% ' --- ---- , f .,rte...._leo.- = - -- -- - -- FINAL INSPECTION BY--------------------�-------------------------- Date-----�- -. ------- 4--------- --= ----------- --------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street . 814 North "C" Street !30 South American Street Tree California Stockton, California Lodi, California Manteca, California y. Es-9-2m 145496 ATWOOD 1z-s4