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/ APPLICATION FOR SANITATION Permit No. ...�� � ,,�( ATION PERMIT ------------------ 1 (Complete in Duplicate) Date Issued Tglica--ion is hereby made to the San Joaquin Local Health District' for a permit to construct and install the work herein described. I Thi liiiiapplication is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND LOCATION.------ 7"--' -- ... -- ---- - - -----------------14- Owlner's Name---------- t� ` -------------- - ---------------------- ---- ----------- Phone--------- -------- ------------ Address - -:�----_•.`"- ----- ----- 1 - - -------- ----------- Contractor's Name---- _ '- ----- '� ''=..1 '----' --- ------------------- Phone E installation will serve: Residence Wpartment House ❑��,,, Commercial E] Trailer Court ElMotel 11Other ID. i. Number of living units: ---- Number of bedrooms ____"Number of baths ---/--'Lot size .....- Wa'ter Supply: Public system`[-<Ommunity system ❑ Private ❑ Depth to Water TableA/ ft. \ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ few Construction: Yes ❑ No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Tank: Distance from nearest well�Distance from fo ndation___�_�_.__.._-Material_____ ______________________ _____--- Septic / i� Liquid de th_.. � " l;�/' No. of compartments z_-------------- Size __ G P � .............Capacity-�F-- Disposal Field: Distance from nearest well ---------- Distance from foundation_._________________Distance to nearest lot line----------------- \` 'I❑ Number of lines------------------------------------Length of each line----------------------..-------Width of french_---------------------------------- Type of filter material------------------------- of filter material---.--------_--------Total length--------._-_--_.----_----------_.---__-..- Seepage Pit: Distance to neares well. '---Distan e om f undation--_�_ '.--'- _.Datance to nearest lot line____ _ _.Linin material_ Size: Diameter__ �t ___ Number of pits--- - ----------- 9 � - ---- �-----; _ -Tti ---.Depth - ------------------- Cesspool: ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining'material_-.__._-----___.____._._----------- . 4n Size: Diameter---- - --------------- -------- ------ Depth------ ------- ------------------- ----------------Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well--------------------------------------- --- nearest building- --_ ❑ Distance-fo nearest lot'line ------------------ -----$----------------•-�--------------------------- -4--------- ---- -------------------'-------------------- Remodeling •- -------------- i Remodeling and/or repairing (desZpbe� e------ - ------------------------•--•----------------------------------;--'---------------------------- ..--------------- Wit-- - ---- - =--- "e�`-�`-�-------- ------------------------------- IM . -------------- --------------------------------------------- !. I hereby certify that I have prepared this .application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and r*Ajn �gions of the San Joaquin Local Health District. it Septic Tank Service Si ned Contractor) r By------------------------------------ tockton, Colif: r_. . Title----- :, ---'�---------------------- plo+ plan, showing size of lot, location of system in relation to w Is, bZuildings, etc. can be-placed on reverse side). �i FOR DEPARTMENT USE ONLY --- DATE ' APPLICATION ACCEPTED BY.._---------------=---------- ------------.-1---- RfVIEWED BY------ ----------------------------- ��' DATE = ------------------------- BUILDENG PERMIT ISSUED--------------- ---------- ----------- -- ----------•--------- -- DATE------------------------------------------------------------ Al+erations and/or recommendations------------- ................ ' ----------- _•---------•-------------------------------------------------------------------------------------- ------ I� � f ---- ----------------------- ------- ---------------- ------------------------ - --------------------------------•-------------------- I ----------•---------------- --•-------------------------•--- ► ----------------------- ------------------------------ FINAL INSPECTION BY: ----- ---------- Date----- -----u---y� ------------- ---------------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT � 130 South Amerit'an Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockton, California Lodi, California Manteca, California Tracy, Cilifornia e5-4-2M 14SA46 ATWOOD 12.54 j