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APPLICATION FOR SANITATION PERMIT �""% Permit No...4140.... �> (Complete in Duplicate) ' � // Date Issued ____._.._..1�__ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to c ruc't and install the work herein described. This application is made in compliance with Co my Ordinance No. 549. JOB ADDRESS DLO TIO ..............................PI/- ----------------•---- Owner's Name. T - ------------------ Phone Address-------- f. • Contractor's Name------ ••-•--••--....••-- - --------------•--------------------------------------------------------••----•............................ Phone_ ..---•----•--------••---••--•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M�ot`ej ❑ Other ❑ Number of living units: -1-___ Number of bedrooms 3. Number o baths ._/--- Lot size ...�Q _ .Q�.`....................... Water Supply: Public system ❑ Community system ❑ Private I^epth to Water Table ........ ft. Character of soil to a depth of 3 feet---Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes ❑ No an Construction: Yes 9NNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ubpc sewer available within 200 feet.) e Septi ank: Distance from nearest wej_._•7.!-'Dist a fro foun` ''on... ....07........Mater h_.____.____. No. of compartments_-.--_-_- -___,Si e •�_ ._��?__.Liquid 4ep.6----____ `___------Capacity....- _.. Dispos Field: Distance from nearest e �istance from foundation r .%Vl! ' Distance to nearest lot line.. _.. ue Number of lines_________ __. __ _..__ __Length of each line-------- __ Width of french--9 rl---- I.._.._.. Type of filter materi -I--- of filter material-- ------Total length -••••-- Seepage Pit: Distance to nearest well-.___--..__-__-_.-__Distance from foundation....................Distance to nearest lot line-___-_-_-__•----- ❑ Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth----------- .-.___----..-.---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_..___.-----_--_.._........_....... ❑ Size: Diameter-------------------------------------Depth----------------------------- ------------------Liquid Capacity----------------------------gals. 6 Privy: Distance from nearest well .---------------------------_------------Distance from nearest building_______________________________ ❑ Distance to nearest lot line------------------------------ ---•------------------------------------------ ----------------------------------- Rem deli and/ repairing (descr tl vl ---------------------------------------------------------------------------•-• ••--•--•-•--••-•-• ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and s and re ulations of the San Joaquin Local Health 06*ict. -- ••---• ---•...-•-------•• ------ --- -- ----------------------------------- ------------------- ----- Owner and/or Contractor (Signed)------`--f'�--{- ( � ) BY: Ar - .��- -- -----------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan,-showing size of lot, locati system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY • --------------- DATE REVIEWED BY ,.: -------------------- -- - - - DATE----Q-- ................................. BUILDING PERMIT ISSUED------. ........................................................... DATE Alterations and/or recom ndat' ns --------------------------- ------_------•-. -.__ ----- ._.. ��04 �c -- g 4V ------- - - ---- NNALINSPECTION 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 ES-9-2M 145446 ATWOOD 12-54