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APPLICATION FOR SANITATION PERMIT Permit No. ...1.1--o..... Com lete in Duplicate) a. ( l P Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and insf fl the w�rk�e_4 described This application is made in compliance with County Ordinanc o. 549. �i.� Gt �-►_ / .l JOB ADDRESS AND LO ATIO =._.Iflr -- -- -- �' . " . c. - ----- - f Owner's Name----------------- x---� -- b / ---- ---- °n�iCT Address---------------------- - -•------� -- ------------- -- - -------,�---`-�r----- ` Contractor's Name__. d - Phone JRA- ------- Installation ----`Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑_ __ Number of bedroom-- Number of baths -14Cot size __ -- --�`3 - Number of living units: _-� �• Water Supply: Public system ❑ Community system ❑ Private p5- 9-�th to Water Table Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [jj__W&*an ❑ Previous Application Made: Yes E] No �w Construction: Yes �❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 fee.) "I �_ Distance from foundation Material " Septic Ta from nearest well p - -----------------------------1�04- Distance .Size__ 6 3� _Liquid depth..._+ a--��--- ._Capacityle-0.No. of compartments_.....---------- -- -// ,� r- ��'t".Distance to nearest lot line_.-____ Disposal Field:. Distance from nearest we1IZ/"._. _Distance from foun ation___,� Number of lines---.-- ------ Length of each line------- --- - -- - --- --Width of trench--- .-- 1-1------------- --------------- X �1 �/ n - ii V Type of filter material.--/ .-Depth of filter materia_---.,1. ._..__-_Total length___.__ ir Seepage Distance to nearest/we11..1Q[�.- ----Distance m f ndat ___(¢�_-____. t ce to nearest lot line---- ion 3 Number of pits-----f--- ----------Lining material__. ._ .-Size: Diameter__- -�---------Depth r±�_��__.________ Cesspool: Distance from nearest well---------------_Distance from f undation----------.-------- Lining material__.-----.---__.______________---_____. 3 ❑ Size: Diameter_..- ------------ - -------- ----- -Depth--------------------------------------- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_------....._------------------------------------Distance from nearest building------------------------------------ ----------------------------------- . ---- �i ❑ Distance to nearest lot line.------------------------------------------ Remodelingand/or repairing (describe):--------- ---------------------------- ---------------------•--•------•-------------------------•-----•-------------•------------------------•----------- aI •---------------•-------•--------- y -____ ___________________________________________________________________________________ _ _ _ ______________________________________________________________»_______________---__________________.»______..___________-_______-____..___ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rules and egulati°ns of the San Joaquin Local Health District. .---� ------ --_-- 8avner 'a-Contractor) (Signed) - -------------- - _L -------------------------------------- - --- -----(Title)-- (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ---- --- -- ----- - -- -- ------------- -------------•------------ DATE--------- REVIEWEDBY------------------------------------- - -------------- - ----------- --------------------------------------- --- DATE-------- ------------------------------------ BUILDINGPERMIT ISSUED----------------------- ------- ---- ---------------------------------------------- DATE------ -----------�-- -------•-------------------- 1,�--- ------------------------------------ Alterations and/or recommendations______________________ ------------ ------------- -------------- � � -- ----------------- ----- - -------------- -------------------- ---------- ----------------- ------•-----•---- --•--------- FINAL INSPECTION BY:-------- - ------------- Date-------1 -' �`5 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 340 West Oak Street 132 Sycamore Street 814,North "C" Street Stoek+on, California Lodi, California Manteca, California Tracy, California ES-9-2m 145446 ATWOOD 12-54