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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ___ ___________ Applicaa-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. ,f JOB ADDRESS AND LOCATION__ �,f �) .��°__-c�s�_a� .�`�c�ol-.. �_ �f'7�"dS'r`��.--r ��G��!'-- 'r?,rA�--------- Owner's Name--------- 27eL t��- �$ `¢ Phone Address-----------------------�o.d _. - �� 4-- --'---•----------------=-----=-------•-------------------------------------------------------•-- ------------- ----"-. i I Contractor's Name__. ...O"n�f--`d'-. 1I i N '� --a Phone/k__Z7� ,4- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trai r' Court El Motel E] Other �O�slQrw>sst� Number of living units: __.-___- Number of bedrooms ___.____ Number o bba hs /- _ Lot size ?P _____ _ ____________________ `_..___._ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ,Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i A Previous Application Made: Yes ❑ No Ug,-�New Construction: Yes No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well________________Distance from foundation-------------------.Material----_-.-_______________.._______._ 1 ❑ No. of compartments----- --- -----------------Size---------------•----------------Liquid depth-------------------------Capacity.--------------------- Disposal Fie Distance from nearest wel -O----_Distance from foundation----aJ0--4--.Distance to nearest lot [ Number of lines_-�________-- -__ _ -__ ___Length of each line-J-7-P-0______________._.Width of trench------—7--4Z ------------- 0 __.-________ k Type of filter material C, .._Depth of filter material__$......--_____.Total length_____eta_©___f-----____...__.- Seepage Pit: Distance to nearest well--------------------__Distance from foundation--------------------Distance to nearest lot line_____._.__._____. ❑ Number of pits----------------------Lining material----_-----------------Size: Diameter---- .-----------.----Depth---------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation__________-------_Lining material--------------------------------------- ❑ Size: Diameter--------------------------------------Depth------ ------------... ----------- ---------}---..Liquid Capacity----------------------------gals. rn� Privy: Distance from nearest weil-------------------------------------------------Distance from nearest building--------------_-----------------------_--. .f's ❑ . Distance to nearest lot kne-------------------------------- -----p----------s------- --------------•-------------------L-------------------------------•---•-- ------------- Remodeling and/or pairing (describe):-----��`-------ea .t°C. CLC / --•--.f Q'_ f-i, ......�`------------------•-------••-------------- -------------- -- °l.f RSC..- ------ ------------- ---- - -------------------:--------- ---------------------- ----•---------------- ------------------------------------------------- ------------------------------------------------------------•----------------------- I hereby certify that I have prepared this application and-that.the work will be-done in accordance with San Joaquin County ordinance,, aws, and r*A�rj �pl ns of the San Joaquin Local Health District. RT Septic 'tank Service a� r (Signed)..-_-- ' -124t6_So.- Idarado H02" - t"""' r:L ° ' °r Contractor) -7Q48--------- - ---- "�--- Stockton, Calif. �_Title__. By:-------------------- - .. -- ------------ - ( ) (Plot plan, showing size of lot, location of system in relatio o wells, buildings, tc.;� can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _______ DATE~__________________ - ----------------------- REVIEWED' BY--------- ------------------ --- - -------------------------•----------------- - ------------------------ ------------- DATE--- -------------•-------•------------------- tBUILDING PERMIT ISSUED------- --- • Alterations and/or recommendations---------------- ----- ------...------------ --------••••-------------------•-,----..._.------•--......-•--��---•------:--._...-------------• -------- �, --------------•---------------- ---------------------------------------------------- ------------ --------------•------------------------------------------------- ----------------------------------- I ------;-----------------"---__---- --------- ---------------------------------------- ------- f - ,�Pix!t ---------,• ----------------------- ----- f--------------------------------------------------------- FINAL INSPECTION BY:, ,4�__ ---- ------- --------- - -------- Date" -- -- 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 ES-9-2M 145446 ATWOOD 12-s4