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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued i T �,c Applica+ion is hereby made tof the San Joaquin Local Health District for a permit o construct and install the vdork herein described. v This application is made incompliance with County Ordinance No. 549. n-,d JOB ADDRESS AND LOCAT`ON..�/ C/k `' r � � �� - ,t Owner's Name--------- -------- i-r�-/�,� ------- ------ ---------------: Phone-------------------.._.. Address zo--------- ---- "'-------- - • --------------------------------------••------------------------------------------------------------ 11. Contractor's Name-----•--- -•-----4-- A --------------------------------)]------------ Phone Installation will serve: Residence Apartment House Commercial Trailer Court Motel Other may_ g i ----, r of baths ----_.-- Lot size ----- _----------------------------------------------- - --------------------------------------------- Number of liven units: Number of bedrooms _ Number ��,, �.�. r f Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ___�--- tt.` V �! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yves ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4—et. .� (No septic tank-or cesspool-permit#ed-if public sew-eeris available witfiiii 200 feet.) Septic Ta Distance from nearest well__;.________-_Distance from foundation-----------------.-.Material_______-___.__.__.___.-.._._________.___-_-_.._. O r No, of compartments---------------"_-- Size_..-._..-------------------___--Liquid depth.-------------------------Capacity----------------------- ►� : it Disposal Field: Distance from nearest welt.___..'-__ .._Distance from foundation___42-....Or to nearest lot line-3.0------- Number.o� lines-----------1...............- -Length of each line--------�L?_---------.Width of trench.---:t4_4- Type of filter material-. j3.lt'C ___Depth of filter materiaL_..___ Total length......... ,4.0----------__--_f_^__�__ �e� Distance to nearest well------------_______----Distance from fou..ndati�------------------ to nearest lot line__.'_'_________ 1�91Number ol'� pits L material------- ' /� -----Size- Diameter - ---------- -----Depth_..----------------------------- Cesspool: Distance from nearest well-----------------Distance from`foundation_- ._______._..___.Lining material'.___.______---._.__._______:______. { ❑ Size: Diameter- -------------------------- - - - ---Depth----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest weal____ ______ _ ________ ____ ___ ___ Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line------ --------------------- ----------- ---------•---------------- •--------------------------------------------------------------------- Remodeling and/or repairing'(describe)----------------------------------- -----------------------I-------------------------- ^±-- ----------- --... --- .f{` ------------f -- , • r ---------••-----`-•-------=' `--------------`-••--------------- --a------------------------ IM •t --` ----- ------ - -------------- ordinances,bStatetlaws, andhrul s arndaredulations olf the San Joaquin Local l that I this fi' be done in accordance with San Joaquin County C '` g � q Health District. rsrO, •� i , ri; -ate :.� �, I • - ,- �---- ---------------------------- -------------------------------- -----(Owner and/or Contractor) ! (Signed)------- Sy� ----------------_--------------------------- ------------'-==-:=---- T� (Plot plan, showing size of lotlocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ,1 APPLICATIONACCEPTED BY------------------------------- ----------------------- ------ DATE------------------- ------------------------- REVIEWED BY ------- - II-------- M DATE �� ------- BUILDING �M --------- ---- ) 1I - DATE ---------------- -- -- h Alterations and/orTrecommDendations:.------ ------- -------------•-•"------------------------------------•-••----------------•-------....._.. ----------- --------------------------------------------- ---------------------- -- ------- ----- ---------------- --------------- ----------------------------------------------------------------------- ----- . . I� =--------- : -------------------------------- ---------1-- --------------------------._... Date_ --------------------------- ---------- FINAL INSPECTION BY ._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 145446 ATWOOD iz-54J 4� g