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Cl � - 4 q APPLICATION FOR SANITATION PERMIT Permit No. --------------- (Completer in Duplicate) - 8'/ 31, C- -- Date Issued -------------------- 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. 1 JOB ADDRESS AND LOCATION---- �----- r `--- r lY...� ( !'-'`• I Owner' m -- . - j 't -- --------------------------- - ----------------------------------_---- Phone.1_ k-S A(44----•-- Contractor's Name 4..� ------------------------------------ Phone: J----------/----------.� ---- ----- Installation will serve: Residence Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel '❑ Other ❑ Number of living units: ___(..._ Number of bedrooms ..+'.-.-- Number of baths Lot size ��...-_7�./�`C�................. Water Supply: Public system ❑ Community system ElPrivate Depth to Water Table__. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2/'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_2(� -..____Dista,,'']]-ce from fou da ion__._f.O_�.------ }aterial...��- - - No, of compartments-- 1 - ------------------Sizeµ .. �. . ._ ' i uid de th_ _ f1.---_.--Capacity_--...4-0_. , Disposal field: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line----------------- 7(S t,r,q Number of lines-----------------------------------Length of each line-----------------------------.Width of trench--------------_-------- -- Type of filter material----------------------l--`-Depth of filter material .-..--.---------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------I-....Distance from foundation-------.------------Distance to nearest lot line--._....__--------} ❑ Number of pits"--------------------Lining material --------...............Size. Diameter------------------ ----Depth------------------- Cesspool: ---------------- -Cesspool: Distance from nearest well-----------------Distance from foundation-_____________ _ Lining material..._._-........._____......-.__._-.. ❑�. Size: Diameter------------------ ----------------- Dept h--------------------------- ------ ------------------ Liquid Capacity- -------------- =--------gals: E Privy: Distance from nearest well----------------'...--------.---------------------Distance from nearest building.-__----..._.----_ ❑ Distance to nearest lot line------------------------------------------------------------------------- . Re deling and r repairing (describe): A_gS1.l -_v1 W �.�-- -C'�.�_. `.�� AI�_Q�. _. Q 1_` i�•A�- f d•L \ ------------------------I-------------- ------------------------------------ ------------••------------------------=------------------------------••------------------•----•----•----------•--Y•-----------------------•----•---------------------------------- t ! 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) ey:. 9. (Tule) �- (Plot plan, showings a of lot, loc ion 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_-..-...._ - �'�- - Lf ------------------------- BUILDING PERMIT ISSUED------------• -- ---=---•------ ------------- DATE.------ -----------• -- - ------------------------------------•- ------------------- Alterations and/or recommendations------------- _._..----------------------------------------------------------------------------------- r• ------L------------------------- -------------------------------------------------------------•------------------------------------.---------•----------- •----- -------- ------------- ---------------------------------------------------------------------------------------------------------------------------.------------------------------------------------------------------------------ ------------- --------------------- . -- � r� FINAL INSPECTION BY:- - Date �----------------- q .. 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_ZM 14Sa46 ATWOOD 12-54 .- 'tR