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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / /J Date Issued --- g _-� Applica-l-ion is her by-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 Ordin ce No. 549. JOB ADDRESS AND CATION_-- :� '_ a , -.' - .i-- - --------------- - Owner's Name-••- •--p-- --r. -------------- -: Phone------------------ ----------------- Address------- ------------ _.._.------••---- Contractor's Name------------- ------------------------------------------ ------------------------------------------------------------- Phone----------------------------------- Installation will serve: ResidersT Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ umber of bedrooms ._Number of baths .__.J__ Lot size ____/__�3��-__ Water Supply: Public system ❑ Community system ❑ Private { Depth to Water Tablep�'�_' t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-❑, Adobe[ Hardpan E] Previous Application Made: Ye!-,[X No ❑ New 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-_:tt` _&+Distance from fours ation-_AA5. _. dte lal____ No. of compartments.............�------Size__C-1-JO-1__.+ __Liquid dep -----i�.1•-!,�/�� ------- acify..- / -A _-- r ; Disposal field: Distance from nearest well-_ &-0_'�'Distance from foundation..-_.Distance to nearest lot lin ____ a•. t t Number of lines--------- Length of each line___.__ r�Width of trench_-_ ___ p Type of filter mater:al._ 1_ ?epth of filter material____..__.!-___Total length____________________ Seepage Pit: Distance to nearest well---------------------- from foundation_______________.....Distance to nearest to t �.© _ m __ ❑ Number'of pits----------------------Lining material-----------------------Size: Diameter_----------------------Depth-------------------------------_. Cesspool: Distance from nearest well-----------------Distance from foundation__ Lining material-------------_----------------------- p ❑ Size: Diameter--------------------------------------Depth---,-------------------------------------------------Liquid Capacity---------:------------- -----gals. C Privy: J Distance from nearest well-________________ ` Distance from nearest building ?0 < ❑ Distance to nearest lot line--------- 4-------------------------------- ----.-.------------------------ Remodeling a yrreairing (de rite):_ ___ _._-___-_- - :... ` ---------------------------------------•------•-----•---------•-------------------•-- --•--•-.----- _..----------------•----------------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. (Signed) ------------------------------------------------------------Owner and/or Contractor ---- ---- ---- --=------- --- -- ---- B . ---- -• Ti+le-- Y' - ( ) (Plot plan, showing of I , 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---•----- r � -------------- ------------- BUILDINGPERMIT ISSUED----------------- --------------------- - -------------------------- .DATE--------------------------------------------------•------- Alterations and/or r commendations:--------------------,----- --------------------------------------------•-----...------------------------------------------------ -----•-•-- e — — — --------------------------•----------•-------•--•---•--------- --- � "+ -- - -- -- -- -------------"-;.: ---••-------------------------------------------------------------------- -----------------------•----------------------------------------------•-------•--------------_.. -------- --------------- ----------------------•---------------------------•--•---------------------------------------- 1=1NAL INSPECTION BY--------- -----�---------------------------------- -------------- Date-- ._-------- __4_9------------•--•- SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California fi En-y-2M 145446 ATWOOD 12-54