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n APPLICATION FOR SANITATION PERMIT Permit No. --- -`-- J (Complete in Duplicate) Date Issued --_;-- --- 7---- A l Health District for a permit to construct and install the work herein described. Thislica�ion is hereby made to the San Joaquin Loca application is made in compliance with County Ordinanc5No. 54 JOB ADDRESS AND LOCATION___:': ---- - Owners Name_ ------------- ----------- Phone -- ----------=-------------------- Address..../ ..... = on + ------ e'f� Ph Contractor's Name_..- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ -. Number of baths -- --- Lot size . -;--- , _ } Number of living units: ____,Number of bedrooms __ p .-- :�ft Water Supply: Public.system.2- Community system ❑ Private [IDe Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ Adobe ardpan ❑ A € Previous Application ltion Made: Yes [3 No New Construction: Yes 0 140 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permit#ed if public.sewer is available within 200 feet.] s Septic Tank: Distance from nearest well ! '-Distance from foundation---- , ,:�-----Matenal---.,amt '' =-=--•-----9:.----------� No. of compar#meats--------e* ----------}-Size- - -----Liquid depth__ ---- --------Capacity... << :------ nce Disposal Field: Distance from nearest well. --Distance from foundation___. - Width ofttre ch nearest `rine---- ----------- Number of lines______. ___ . '_Length of each line______- - - ---- «; �; e ------ De.th of filter material_----- Total leng#h-______.._ Type of filter material.___t--_- =- ------ P Q .t -� - Distance to nearest lot line__ .- -- M - Distancerom foundation___._-!� --- • y' •, � E Seepage Pit: Distance to nearest well_ - -&4.-.Size: Diameter_- 1210 .10-__--_---Depth---- ------- ------ - � Number of Pt -----------Lining maternal___:- � f � 1 Cesspool: Distance.frorn,.nearest well--------------�Disstar>ce from foundation-------------------Lining material------------------------------ s. i .Liquid Capacity gals. ❑ Size: Diameter- ------------------------=- ------ Depth -------------------- --- --- N Privy: Distance from, nearest well-------------------------- ""--_--------Distance rom nearest bu'ilding------------------------------------------ ❑ -� �• � -"'Disfiance-to nearest Oat line--..__._._"__..__"`"-"----- �"�"--' ------------------------------ Remadeling and/or repairing {describe)________________ ----------------- ---•------------- --•----------------------------------------------------- I - - ------------- -------- •-------- ------------------------ --------------------•-- Sa - ui I hereby certify that I have prepared this application and that the work will be-done in accordance with San Joaquin Count i ordinances, State laws, and rules'and regulations of the San Joaquin Local Health District. Contractor] 1 {Signed} (Title}--- -------------- --- t---- ------ an showing-w - ----•-'------- ------- ---(T ' {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ----- -- DATE ' rL ----------------- ----- LST --,--=--------------------- APPLICATION ACCEPTED 8Y- DATE------------------------------------•------------------- - REVIEWED BY --------------------------------- DATE-- ---- ----------- - -------------------•---...---------------------------------- BUILDINGPERMIT ISSUED----.-•---------------------------------------------------•--------- ----• ------•-------------•----------- Alterations and/or recommendations:------.--___-------------------------........... ------------------------------- --• ---•------------ Date------------------------------------------------ FINAL INSPECTION BY:..---- 1A.44-�- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 854 North "C" Street 13o South American Street Manteca, California Tracy, California Stockton, California I Lodi, California E5�9-2M 145446 ATWOOD 12-54 _ --