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A, APPLICATION FOR SANITATION PERMIT Permit No. 1�. ..: (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. Li l tys i�e JOB ADDRESS AND LOCATION... __ WCL.LI'J_______ .Ch!D O 4b / S t__Ot� i/ic... Owner's Name---•-l_ ....... C/job' Phone--------------------- , ..--------•------------------------ ---------------------------------------------- --------------- Address............ Address-----------. 0y......-2--�...--- VA &.. 14_00. ............... `------ -- . . ------ PhoneZ44..4Contractor's Name C _g Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [t_-xc1koci Number of living units:*-------- Number of bedrooms ........ Number of baths ........ Lot size .!r -'�_ Water Supply: Public system ❑ Community system ❑ Private [ Depth Water Table (,:5.d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [(Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No,OK New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ��N,s�tj�},a��r cesspool permitted if public sewer is available within 200 feet.) t" ! �C isst'ance from nearest well --------Distance from foundation....................Material -------- ------•- ----•------ 1� O7W,S / No. of compartments-----------------------...Size............------------------Liquid depth---------------- .........Capacity----•-----..._.•--••- Disposal Field:( , /N.V f istance from nearest well-.---------------Distance from foundation--------------------Distance to nearest lot line...;--.......... E] x)('13 T umber of lines------------__-___--__- __-.---Length of each line................---------------Width of trench................................... Type of filter material-------------- -----—-_Depth of filter material . __-____r-Total length.:................ Seepage Distance to nearest w ILLOO___ __Distance fro foudtion../.-.o....... D stayp to nearest lot Una � _.__:.I XSize: Diameter_.... .._......Depth------0 �----- --�---- ---Number of pits.. Lining material- rr Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material. ❑ Size: Diameter-------------------------------------Depth------------------------- - •---------- ---------Liquid Capacity -• •---••---gals. Privy: Distance from nearest well --------;__.____:___-_.---._..____._Distance from nearest building.......................................... ❑ Distance to nearest lot line---- ------------------------ -------------------------------------- ... -• •. •--. ...,................................ � jQ qRe deling and/or repairing (describe):.__. _ Is/ - . ski . k .� t -- ----- --- �t ....................................... ------------_------_- ----- -------------------- --------- - -- •--- ... -- ----••--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules and regulations of the San Joaquin Local Health District. (Signed).... t Rl!�.�54ionof --------r •---••----- ------------•---------•--•------•---•------•------------- -••--( r and/or Contractor) By:------ L.-� •-------- (Title)--- -- ----- ------------------- (Plot plan, showing size of lot, Iotaystem in relation to wells, buildings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ---- - -------------------------------------------------- DATE_" .------------. ......... ------•• -•------- • --- --------------- REVIEWEDBY--------------------•••• --. ....... ------------------------------------------------------------------------- DATE. ............. -•--- ..... ..... .BUILDING PERMIT ISSUED--- ------•--------------------------•-•--•----------- ------ DATE....... ................................................ Alterations and/or recommendations-------- --------------- ---------------------- -.............................................................. ............. ---------------------------•-•------=-------------------------------------------------------...-----•---•-------•-----•-----------------•----------...........----•--•----•---•-------•---•------..........------.....-•------ � �� FINAL INSPECTION BY:-- - ---- ----------------------- Date-.::�'.... - - 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 E5-9-2M 145446 ATWOOD 12-54 - -