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0 a APPLICATION FOR SANITATION PERMIT Permit No. ... _ .___ (Complete in Duplicate) 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. 4 JOB ADDRESS AND LOCATION_____-- ___�,.--------------------�___--- Owner's Nameyi1 ------ -------------- ---------- ----------`---- ----------- Address...--•-----------E--l1 ..-f ... . 1-10 _ t --------------------------- •---------------- Contractor's Name------ ---------- --------•- ------••----------------------•----- ---- Installation -Installation will serve: R sidence ❑ Apartment House xCommercial ❑ Trailer Court E Motel [❑ Other ❑ _ Number of living units: _-1_ Number of bedrooms __ .__._ Number of baths Z--- Lot size _ _er��rQX__- -- _L'�---------------------__.__- Water Supply: Public system Community system ❑ Private ❑ Depth,to Water Table ------- ft. Character of soil to a depth of 3•feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam El Clay ❑ Adobe'K Hardpan E]Previous Application Made: Yes ❑ No 1�il New Construction: Yes` 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-L.A-"x--Disfance from foundation_1Q_____-____. aterial__!�-r�_ ----- No. of compartments _._ 3-X-�--x--.- _Liquid de th__. ``,, p Size_ �] q P '7` Capacity fl Disposal Field: Distance from nearest well A -P.Distance from foundation__�_C?__._.____-.Distance to nearest lot lin Number of lines----------'�--------- -------- �engfh of each line-----8_C3-...__yt-------Width of trench.--- -- - -----------_-- T e of filter material_ french---- Type epth of filter material---.1_-_M_ Total length____`c.�,_�Q.--.--__------------- Seepage Pit: Distance to nearest well_.-.-_.-._._----------- from foundation--------------------Distance to nearest lot line________________ ize:`Diameter---- ------------------Depth-----------------•---------- ❑ ......Number of pits______________________Lining mafierial_____..___.__.-__- ---- Cesspool- Distance'`from nearest well_________________Distance from foundation------------------- Lining material__----------------._--_.___.____.__. ❑ Size: Diameter---------------------------- - ------Depth ' -- �� -" '- '- Liquid Capacity---------- — _ qa€s.. ' t ------__, 3 - ___ _ _____• Privy: Distance from nearest well----------------- ------------------/_____-----------'----_,Distance from nearest building______ _ ___ _-___-•-•----------- ❑ -Distance to nearest lot line----------------------------- -------- • I- ----------------------------------- - - Remodeli g nd/or•repaEring (describe):____ .e1 l ---!77n....... ------------- -- ----------•-•-----------------•-----------------------------•-------------------�P-------------------------------------•-----•----------•---------------------- -----------------•---------------•---•------------------- I hereby certify that I have red t is application and that the work will be done in accordance with San-Joaquin County ordinances, S fe law,,a lee and egulations f the San Joaquin Local Health,,Districf. (Signed) yY- - ----- - - ---------------------------------------------------------------------------------------------------{Owner and/or Contractor).. Y:--------------•----------- -- -- ------ ----------------------------------------------------- - Ti#Ie { } •-------- (Plot plan, showing size of lot, locaf of system in relation to wells, buildings, etc., can be placed on reverse side). Jr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- - - --- - ------------------------------------------------------------ DATE---- -�-------------- ----------- -� ------------------ REVIEWEDBY--------------------------------- -- --------- ------------------------------------------- DATE----- ------�-.. I BUILDING PERMIT ISSUED DATE.--------- ` 11-Alterations and/or recommendations:--------------- ->-- - ----------------------------- ---------------------•----------------------------- -------- ------ ---------------•------------------------------•------------------ -------------- ---- ----- --------•-------------- ----------------------------- °----------------------•--•------ -- --- ------------------------------ -------- ---------•---•---------------•------------------------------------------.---------------------•-- FINAL INSPECTION BY:---- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I, Stock+on, California Lodi, California Manfeca, California Tracy, California �` 9 145448 ATWOOD /