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ley APPLICATION FOR SANITATION PERMIT Permit No. ____/._3.7-. (Complete in Duplicate) - Date 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 ATION___.____1__26._--3-- .___ ___________ _ - ----- 7 !/ Owner's Name = , ---•-------•-------------- --------- --------------------------------------- Phone-------------1.-� _7 Address------------------------------------------- Contractor's -------------------------------- ------•Contractor's Name-- 4_W @� •(L� -------- ------- ' -,-------------------------------------------------------- Phone�__�._---R�_7C)�i Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel El Other El Number of living units: __ Number of bedrooms -_Number of baths _/___ Lot size ----x__7 __._ __ -_•--------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes p No TYPE OF INSTALLATION AND SPECIFICATIONS: _ANo septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Tan Distance from nearest well ______________Distance from foundation-------------------Material--------____._____-_-___-___________________---. No. of compartments---------- --------------Size---•-----------------------------Liquid depth------ -- - ---- ---------Capacity----------------------- l s Disposal Feld: Distance from nearest we I_6`71„__„_Distance from foundation_/_�.- ---.Distance to nearest lot line._______. Number of lines 2e _-- - Length of each line_F� ---,$� -----Width of french----.�_�`�-------_-_-•- Type of filter material____ _�/ Depfih of filter material__`j_g---------_Total length----,�_2,.r?__�'_________________ Seepage Pit: Distance to nearest weLr____._______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. "Vt Privy: Distance from nearest well----------------_------------ -------------------Distance from nearest building------------------------------------------ 4 ❑ Distance to nearest lot line--- - - --------------------------------------- -•-------------------•------------------------------- �r Remodeling and/or repairing {describe}------------------- -------------------------------------------•---------------••-------------- ••-------------•------•-----•-------•--- --------------------------------------------------------------------------------------------------------------------------- --------------------------•----------------------------- ----------------•-------------------- --------------------------------------------•------------------------------- - w_ _ _.. -------------•-----•- -------------------------------- _. 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 & NIGHT (Signed)------ Septic.Tank-Ser.vice-------------------- ---- - ------ -------- - -----------------------•-- ----- Contract 1206 So. Eldorado HO 2-7046 or] By:----- - Title-_ ----------- .- - -- -• ---...-Stacktan;-Calif-------- ---------------- ---- ---------• ----------K-a -- (Plot plan, showing size of lot, location of system in relation t ells, buildings, an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -- - -------------- DATE ` REVIEWED BY-------------------------------- ------------------------. DATE__!w-------•------------- •------ BUILDINGPERMIT ISSUED------------•--------------------------------------------------------------------------------------• DATE-------_G_�--_—_------------------------------------------ *Alteratio and/or*-d/ recoml�e-----------------------------eA.--t "> 1�- . d�R. 1• .%i_1:_6� .1 � a� � ;--------------------- � N "={ / -- - - ------------- €.---.s------•-----t ________�_C_ - r`.j_• 4. - '-- -----------`�-- -- - = � ._. .. 0 40A FINAL INSPECTION BY:----- ------------------------------------ Date I `' 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 146446 ATWOOD 12-54