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�1,V41IT Permit No. ...7' --•�-y, (� 0 APPLICATION FOR SANITATION PERM (Complete in Duplicate) Date Issued ___. d install the work herein described. sz 3 lica+ion is hereby made to the San Joaquin Local Health District for o a permit to construct an This application is made in compliance with County Ordina ............. JOB ADDRESS AND LOCATION.......FT-- f .......... - __.s7____________________ Phone__._....-•----------------------•--- Owner s Name-------s6t--.-------- Address------- """"%' Phone -----_---- Contractor's Name------ Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other Number of living units: ___ __ Number of bedrooms ...:7--Number of baths ._1-_ Lot size th to Water-Table A-0. ft. Water Supply: Public system F1 community system ElPrivate 0,__Dep Loam[Idy Clay Loam ❑ Clay ❑ Adobe[g---Hardpan El Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ San No [/�.-- Previous Application Made: Yes ❑ No r�'`N ew Construction- Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tok- Distance from nearest well------------------Distance from foundation_________________ Material Capacity-__--- p❑ L-Xf5'110 No. of compartments----------------•---------Size------------------------•-------Liquid depth __---•------ --- Disposal Field: Distance from nearest well_._._._._-._._Distance from foundation------- ------.W�t�Distance est lot line------------- ❑�i(rS�I�1y Number of lines-----------------------------------Length of each m --------Total length------------------------------------------ Type _-- ------ ------------- // Type of filter material----- -- --- ----- ---Depth of filter material ----_.- pit: Distance to nearest well....l�"�--------Distance from found5izenD �ter__.3. Ae--t-Depthst lot line. d----- Seepage -Linin material. _I. Number.of pits-------/----------- g material _ Cesspool: Distance from nearest well----- -Distance ce from foundation:-------------_- Liquid Capacity_ :-_--__--__-._--.._-..___gals. ❑ Size: Diameter p ------------------------- Distance from nearest well --_- --- ____.___Distance from nearest building------------------------------------------ Distance ____ _________ Privy: ❑ Distance to nearest lot line--------- ----- - • ...............................•- Remodeling and/or repairing (describe):____---� ,- -- ----------•----------•------- repared this plication and that the work will be done in accordance with San Joaquin --------------- --------------------------ap- ----------- - -------- ----------------•----------------- -� County 1. 1 hereby certify that I have P ordinances, Stat laws, and rules and 'regulations of the San Joaquin Local Health ( nor end/or Contractor) Signed_ •------• --•- ------- -- ------------------ ------ ( 9 ) )Title) i -- ------ ............ (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_.._-.-- •- ---- APPLICATION ACCEPTED BY -------------- --- DATE--------- --- REVIEWEDBY------------------------------------------- DATE .---•-------- ----- BUILDING PERMIT ISSUED-------------------------------------- . •. --------------------------- Alterations and/or recommendations:----- ..-,_ _ ------- ------- ............................ --------•--....... ,� 1 --.-------•-------- ------------- - --- --- ------------ 1 ---- ----------- ------ ------- ................. z Date---------------------------- .----------•----------------------••-----...... ` FINAL INSPECTION BY----------------------•- -------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C"Street 300 West Oak Street 132 Sycamore Street 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M 145446 ATWOOD 12-54