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' Permi Ngo. _... f_- '�� APPLICATION FOR SANITATION •PERMIT _ J (Complete in Duplicate) Date Issued _.._ 1 ,_w 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 LOCATION_----` --- -- ---'r¢_---- _t'J'o�f__._! '- ----------------------• 1. ---------'----------------- ----•-----------•------------------•-- PhoneAa-5117- ---------- Owners Name-----Ca-1-16-0--ft---- ---�--�'- -r-�------•------------------------------------------------- s ., Address-------�� f _ .a t.tc, ----------------_-'-----------------------•-------•-------- Contractor's Name Phone. . Y Installation will serve: Residence Apartment. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' l�' p Number of living units: ___1__ Number of bedrooms. Number of baths --1-___ Lot size ___$'_ _ --: r---------:-------•----------- q - E_.-. Water Supply: Public sysfem [a' Community,system ❑ Private �iPepth to Water Table 5-0- ft. Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay �am El Clay E] Adobe Hardpan E] Previous Application Made: Yes ❑ ElNo [ New Construction: Yes ['No El TYPE OF INSTALLATION'AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank; n'stance from nearest well__,_______________Distance from foundation___ '".._______.Material______._____._____.__.__ -------------------_---- Liquid depth--------- -Capacity I . of compartments.- --- ---:-�-..- ----Size-------•----•---- -------------- ----------------------- " - Distance to nearest lot line..__4 isposal Field: Distance from nearest well 3.7.' Distance from foundation_-le-Q-'..____ Number of lines__-- _/--------------------------Length of each line-.-----,U---- ----.Width of trench.----------- 2-�------------ ❑� ./Type of filter material_____ro-c�_-------_Depth of filter material--------- --------Total length_________________1��_+�--.------•-- w --------------------- Distance from foundation....................Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well...___ =y - Lining material------------- D -------Size: Diameter-----•----------------. epth--- ----------------------------- ❑ Number of pits .D Cesspool: Distance from nearest well_______ _________Distance from foundation----- ------------- Lining material------------------------._________.__. ❑ ------ Derpth--------------- -------- ----- -------------Liquid Capacity_-------------------------gals. � Size: Diameter________________________ --- --- Privy: Distance from nearest well-------------- ----Distance from nearest building.-------------------.--------- ----------- ❑ -------------- --------------- ------ Qistan'ce to nearest lot line-------- ------------- --k------------•----------- 1 Remodeling and or repairring es ------------------------------- -- .----- ------------------------ I hereby certify tha+;I have prepared +his application and that the work will be done in accordance with San Joa uin County q ordinances, Stat Laws, and rules and regulations of the San Joi uin Local Health District. Y ______________.--------(Owner and/or Contractor} Br-------------------- - ------ - - (rile} (Plot plan, showing size of lot, location of-system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- - DATE__. REVIEWED BY-------------------------- ----------------- -- ----------------- ------- --------- ----------------------- - --------- DATE------------------- - " -------•--------------- BUILDING PERMIT ISSLIED. DATE------------------------------------------------------------ Alterations and/or,recommendations------------------ ------- ----------------------- --•-------•---------------•------------------- - ----------------__________ ------------ --------------------------------- --------------------- - v -------- -- FINAL INSPECTION BY:_ ____________ ------ Date......` --------�-- -� - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street frac California Stockton, California Lodi, California Manteca, California y. 1-IV--6-C 7 R E5--9-3m 145446 ATWOOD 1z-54