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7� APPLICATION FOR SANITATION PERMIT Permit No. .... ,.,(y (Complete in Duplicate) Date Issued ___---------- /TA .__l��s� , ``00 '' t construct and install the work herein described. Applica+ion is hereby made to the San Joaquin Local Health District for a permit o Ts application is made in compliance with County Ordinance No. JOB ADDRESS AND LOCATION--- ---- 0�-5�------ -- t------ Q rn ell- C ---------- - -------------------- Owner's Name- &*,K ----- s ------_._. Phone-,------=-- �---------------------- j -- - - -•---�------------- --------------- ----------•-r----------•--------------- --•-•-._...--_..--------------•----- Address ----- - LnLl/I--I------- - Phone----•------u--- JContractor's Name------ ------- C ------- --- -- -- Installation Installation will serve: ResidencetJ Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other-❑ Lot size ------------------- r Number of living units: ----1__ Number of bedrdoms ___Number of baths _ ___ ,7/ ------•-------- Water Supply: Public system ❑ Community system ❑ Private /Depth to Water Table---------- ft. Character of soil to a depth of 3 fee+: Sand E] Gravel 171Sandy Loam ElClay Loam E] Clay ElAdobe M"/Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tapk: Distance from nearest well_________________Distance from foundation_.____________. _.Material ---- ------------- - -------•---------- ----• € „� y Liquid de th----------------------- - Capacity vp+'( No. of compartments '” ' - Size -----•---- q P. ----------------------- No. --------��:---- Di�posai Field: Distance from nearest well_�f___.._Distance from foundation____/0'Ir .--_---..D-sstance to nearest lot lila_________________ Xtti1� Number of lines------------------ -«�-------Length of each line---- -----fr.--- Width of trench_-- _ -------------------- I F �C1s._Depth of filter material----14-----------Total length----175"_-1------------------------ Type or filter material -'.�___ Seepage Pit: Distance to nearest well_.�� ---------Distance from�foundation_,510_1-.------Distance to nearest lot line_�____________ `y t Number of pits._. _f------------Lining material_[°ClQ�y��tG---Size: Diameter ` Depth--- � C 1 Cesspool: Distance from nearest well-___.__-________Distance from foundation___________________ Lining material__.__ - f �. ❑ ------------Depth------------------------------ ------------------- Liquid Capacity ; gals. Size: Diameter'- ----------- -------- i ---- - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------- ------------------------------- 11 ❑ Distance to nearest lot line--------------------- - --- ---••-----------------•-"°-------- ------------------------------------------- ------- ---- - Remodeling and/or repairing (describe)--------------------------------------------------------------------------•-•--------------------------------------------------------------------------- ---....__I------ ------ -- -------------•---------------------------------------------------•-•------------- ---------------------------- ------ ------------------------ -----------------------------------•------------------------------------------------------------. ------------------- ! hereby cert' y hat i have 4p')red this ap '. ation and that work will be done in accordance with San Joaquin County ordinances, Stat 1 S. and rule a re the San Joa in ocal Health District. Contractor) Si ned -- - ( 9 )-------- -------- ---- - + locations system in re {Title)___ ------------- -- By: ••------ •- - - 1 [Plot plan, showing size of lot, y ation to wells, buildings, etc., can be placed on reverse s' e). FOR DEPARTMENT USE ONLY APP RATION.ACCEPTED BY__ ______ DATE d�--------------------------------------------------- REVIEWED BY-_'_------------------ _ DATE ---------- ---- --------- BUILDING PERMIT ISSUED------------ --------------------------------------------- - DATE � Alterations and/or recommendations:---------------------------- _ ----- - --------------------- ----- -------------------- -------------------------- ---------------------------- - ------ - - ------------ --------------------- -----------•---------- ---------- ' F Date.-------8----�-----------�--_---- ----------------------- FINAL INSPECTION BY---------------- - ---•--------------------- 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 - g$-9-2A4 145445 ATWOOD 12-54 ,