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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Appiica+ion is hereby made to the San Joaquin Local Health District for a permit f construct and install the work herein described. This application is made in compliance with County Orc�i�ance N�� 54�. ►f !� a� ------- --------------------------•-----------------•-------------- JOS ADDRESS AND -0 ATION.____I- -- - -7 ----"------ ��, = � --------_-- PhonelTr�_'?�®j8 Owner's Name------------ - ll , - ------- Address � ... Phone// Contractor s Name________ "" " p Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence ;a Apartment House ❑ Commercial F] Number of living units: --`---- Number of bedrooms � Number of baths -I----- Lot size __ _��:_ Water Supply: Public system ACommunity system ❑ Private ❑ Depth to Water Table% ft. h Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No K TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) , G51_21-4-- /" D--- ---._.Maternal----- .`-''_L"'---------- Septic -------•• Se tic Tank: Distance from nearest we1IAte Cr Distance from foundation_.f_- Ca acit f�cw C7C7 p li -Size-S - '----AA-h:__Liquid depth S p Y M No. of compartments-_0... ............... , r 1 Disposal Field: Distance from nearest well/I'�lj�•L .Distance from foundation__fr� Distance to nearest lot line--%S�____-.- ----------- Number of lines--------------------- /�--------Length of each line--- _ ----- qi------Width of trench---141-_!---------•----------- {� Type of filter material-1 ,7.0��L�-fC--Depth of filter material-_____f ---------7otal length____.--ism___-----------------f____. \ Seepage Pi}: Distance to nearest well_: ° t�___•Distance from -fo' ndation___ �-—��--Distanje to nearest lot line___________ r I a Number of pits-> -- �� Lining material__. _. A _ _. Size: Diameter-- $'3-- ---------Depth._..1ZS----------•--------- t Cesspool: Distance from nearest well_________________Distance from foundation----;-------------:dLining ing Camaterial ---------------- ----- -------gals. ❑ q p Y--------------------------- Size: Diameter-- -------- ------- ------- -----Dep#h----�----:------------ -- ---------- ----- - -----"-.-Distance from'nearest building------------------------------------------ i Privy- Distance from nearest well-_.-.-,_-----------_____----- ❑ Distance to nearest lot-line------ ------------- (/ Remodeling and/or repairing (describe):------------- f 1------ ------------------------------------ --•------------------------------- •------ I �3r �r ------ - ; -------------------- ---------------------------------------- I hereby certP'layws"..'an ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staterules and reg tions of +he San Joaquin Lacal Heal#h District. __.--(Owner and or Contractor- --------------------------------- (Signed)----------------- -- i.� (Title ;By----------------- buildings, etc., can be plat on reverse side]. (Plot plan. showing size of lot, location of system in relatio to wells, FOR DEPARTMENT U-SE ONLY DATEz� -------------------------- APPLICATION ACCEPTED BY ~'-�`� ---- DATE ------- REVIEWED BY------ -------------------------- ----- -------- ----------------------------- - -4------------------------------------------------ -----"-- DATE..--------------- -------------------------------- -- ------ ---- BUILDING PERMIT ISSUED______________________ Alterations and/or recommendations:.._____._--- -------------------- - Y ------------ _--__________________________----- .. . ....... _ ._-•-----,-. ----' ... ... Date. FINAL INSPECTION BY.-- ----- ---- -- - ---------- SJR ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S eamore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California . Lodi, California Manteca, California Tracy. California ES-9-21VI 145446 ATWOOD, 12-54