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r L+ 'firW,? a�3S� CATION FOR SANITATION PERMIT Permit No. __.15_613.... 4zl (Complete in Duplicate) �Date Issued ....._Ao -S Applica{ion is hereby made to the San Joaquin Local Healtk6istrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 9. JOB ADDRESS AND LOCATION...... ------ -- -------------------------........................ Owner's Name. ._. s -------- .................................. --- ------ Phone.......................... Address_.._ / /_._._./� Contractor's Name.--------•••-- ..a .. ,. --- --------------- ----------------`---- Phon9�4b_`G, i- la . Installation will serve: Resident//e Apartment House [:] Commercial E] Trailer Court [j Motel [I Other ❑ /-- Number of living units: .... Number of bedrooms .C;?P-. Number of baths . /-... Lot size -y ..................................... f _ . Water Supply: Public system ❑ Community system ❑ Private [&-Oepth to Water Table .Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti ank: Distance from nearest well-----------------Distance from foundation--------------------Material----------__-_-__-__-.,__.-----------__--___----. leu No. of compartments------- ---- --- ----Size--------------------------------Liquid depth.------------- ------._. Capacity--- ---- Dispo al Id: Distance from nearest well_________________Distance from foundation...____...._..__....Distance to nearest lot line................. Number of lines-__-__________________-----------Length of each line---------------------------_.Width of french................................... Type of filter material_________________________Depth of filter material-----------------------Total length.......................................... Seepage it: Distance to nearest well....6,-'.�7?----------Distant m fo ndation..a 4...--..._.Distanceto nearest lot line-/ ------- Number of pits.......___..______Lining material...��._1J_.�/_�'__-Size: Diameter._.....-�...3---.-----Depth----- S _________________ Cesspool: Distance from nearest well-----------------Distance from foundation----------------.---Lining material___-__-__.__________..___...-......... r� ❑ Size: Diameter------ -------------------------------Depth----------------------------------------•-- ------..Liquid Capacity.................. gals. Privy: Distance from nearest well__.__--_--.._.._________-____________________Distance from nearest building.................................. ❑ Distance to nearest lot line--------•----------------------- Remodeling and/or repairing (describe):------------------------- --------------------•-----•--•---•--•-•••----•---•-••---•----••-----------•---•-•-•-•----•----•----•-•------- ...------•------------------------------------------------------•-------•---••---•------•---•------••••---•---•-•-----••--•--------•--------------•------••----•------.................................... -----------------•------------------------- ------------------------------------------------••---------------------------------........................................................---------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc S e ws, and rules and re lations of the San Joaquin Local Health District. (Signed)--••- --- ............ --- -- - (Owner and/or Contractor) By:................... t ........ t '-- ... Title a--------------------------------------------------- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............... DATE-------&-- REVIEWEDBY------------- ------------------------------------------ --•--- DATE--- -; BUILDING PERMIT ISSUED............--------- ---------------- -f ------•----•---•-•......--•-•----•••..... DATE. Alterations an or recommend ti ----------------------- + ` at. i�� -----•- --- - . .. ----•-•------------------•--•------................................... ----••......••------.......--•---......••----.. ....................•••-......--••----- --------------------•-•-•--.-.---.-•-•------•---•-------------.------------•--••---.--.---•-----•-----•--••---•-------••----•----------••------•...-----•--•-----•-•-............•-•-••....... ......................................... ....•---------•-----.......----.•-•------•--------•---------•-..._._......--•--------•..........------•-•--••------•--------:..-•----•--•---------------- ----------...---••- FINAL INSPECTION BY:.........G 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 145446 ATWOOD