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APPLICATION FOR SANITATION PERMIT Permit No. 3_-- (Complete in Duplicafe) Date issued _`�/�-/5�•--- Applicalion is hereby made'.to the San Joaquin Local Health District for a permit fo.-construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 3 1 Cj JOB ADDRESS AND OCAT N-___ #--I.__ _" r/ ------- Owner's-Name,---------- _� - - -�-- ----- -- - - - ----; -- - --------- - ------ ----------- -. Phone.------- Address------- ----------- i ------•-----•------•---- Contractor's Name----- ------ -�_ -•_ 'e" ;� Phone-" Installation will serve: Residence A arfinent House Commercial ❑ Trailer Court E] Motel ❑ Other f-- s ❑ Number of living units: _ __" Number of bedroom _- Number of bafhs 1teot size -----_ �-c-ex— Wa#er Supplyi Public Community system ❑ Private Ej'1D"epth to Water Table_ ft. Character of soil to a dF]epth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay �� ❑ Clay [I Adobe [hardpan ❑ Previous Application Made: Yes E] No Lf New Construction: Yes ❑ No ❑ /Q J2cz.. TYPE OF INSTAE.LATION AND SPECIFICATIONS: (No septic fank'or cesspool'permitted if public sewer is available within 200 feet.) $ c T Distance from nearest well-----------------Distance from foundation--._-" < Material ,No: of compartments_.... Size -•--Liquid depth---------------- --------Capacity osaield: Distance from nearest well------- ---.-.__Distance from foundation__-----------------Distance to nearest lot line-------.-_--_.- Number o dines------------------------------`-----Length of each line------------------------------Width of french Type." filter material------------------------ . e.,� �. ----------------Depthof filter material-------------- --f--Total length----------- t Seepage Pit: Distance to nearest well__!$---------_Distanc wrom undation___ )� --.__.Dist �� to nearest IQt line_-s�---""_"-_ 'Number of pits.._-"� _"..-__--Lining material- ____Size: Diameter-&-6.11 - -----Depth "rte Cesspool: Distance from nearest welt-----------------Distance from foundation.... ------------- Lining material---__--_-"--_._ --------------------- ❑ ., Size. Diameter----------- ------ ------ ------Depth............................... ------Liquid Capacity -------gals. Privy Distance from nearest well------_----------------------------------------._Distance from nearest building " Distance to nearest lot line___-----------_ Remodeling and/or repairing (describe J----------------------"----___--, ------------------------------------------------------------------- ------"•-------------------•---------------------- -------------------------••------------------ --- hat'l have prepared this application and that the work will be done in accordance with San Joaquin ere t -- = -•------------------------------------"------•----------------•------------------------------------------------------------ I hereby certify tCounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 DAY &NIGHT (Signed)--. ---------------septic-Tank-Service------ ----------/,611s, ---------- ----- ----------- Ir Contractor 1206 So. Eldorado HO 2-7046 B . --- ------•-----Stacicto-n;Calif:------------------- (Title --- --� - -- - - ------------------------------------ of plan, showing size of lot, location of system in relatio buildings, tc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE- -------•-------"--- - ------------------------------------------------------------------------------ -- ---------------------------- lEW1 D BY DATE BUILDING PERMIT ISSUED------------------ - ---------------------------- DATE.- Alterations and/or recommendations:-- c-------------------- �' - ---------- ---•------------------------ �.✓' t..� �.p--"=-•-----• --- •--------------- -- - ----------• •------ --- ------ -------------------------------------------- --------•- •------------- ------•-------------------•----------- -------------------------- FINAL INSPECTION BY--------------------------------------- Date.------ -- -------------- SAN - ---."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 Es-9-2M 145446 ATWOOD 12.54 '