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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) .Date Issued __________ A 2S.o zto'-0/ Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with County Ordinance No. 549, JOB ADDRESS AN O TION:- T„/ [ !� ... - ---�------ ---- ------------------------------- n 'f• Owner, L----'s Name---- --- ------ P o e Address -- •--_lam !_- __ ., P� t --•-------------- �� Contractor's :Name----------- ------- %--------------------- Phone_ .___-..-•----------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �_. Number of bedrooms C,.-�- Number of bat serer.__ Lot size _--- -- ----------------- Water Supply: iPublic system ❑ Community system ❑ Privatt"vDepth to"Water Table _�Tft. Character of.soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ' New Construction-. Yes No ❑ TYPE 1OFA 1 S-T-ALLATIOWAND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) —Septic T k Distance from nearest well------------------Distance from foundation-------------------Material------------------------------------..-.-----__-- Q --Li Liquid de th---------------- ------Ca.-Capacity (� No. of compartments-------------------- -Size------------------------•----- q P. ---- P Y----------------------- 1Pee • d: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--___.---------- 6 ____------Length of each line--------'------------ ------"Width of french--------_-------------------------- Number or lines_________________________Type of filter material-------------------------Depth of filter material-_ _.___.--.-...-- ---.Total length_-__-----_----.-..---_-_--_-__----_-_-_.- it: Distance to nearest well.. r--v-Distance f om foundation___. . -_.__.Distance to nearest to ___ -±: �� r ' Number of p1fs. - --------- ----Lining materia .fir ._.Size: Diameter.. ------------Depth- .-----�'_Y - n� f Cesspool: Distance from•nearest well------------------Distance from foundation.___ _. .- sg rdf�-r�ial I, ElSize: Diameter--F-- ----------------------------- 1 De,oth'-.-------- ------''A------- __ .Liquid CapaaitY- ---------- gals. Privy: Distance from nearest 'well.-'.._.._- -_._. ---=-_1_.-. Distance from nearest/building _. - --- r t ❑ Distance to nearest lot line.. 41e!4T, �` q' =r '-_®. p_' o""� t Remodeling'and/or repairing (describe):- G - 'r---- !--�1 •• ?=c== ------ --- --- - - --- _--- bf that I have re are this application on and at the work will be don in accordance with San Joaquin County ere Y Pp Y ordinances,;State laws, and rules and regulations of the San Joaquin Local Health District. ---------------- (Signed)--- = _ u / - -- ---- _----- -- . . _. Owner and/or Contractor) 8 !�f ------------------ ---------••----------------------------- {Title) Y. u --------- (Plot plan, showing size of lot, to ation of system in relation to wells, buildings, etc., can be placed am erse side). FOR DEPARTMENT USE ONLY 6� APPLICATION ACCEPTED BY= DATE_ ---------------------------------------------------- REVIEWED ______________________________-.._____.._.-__- -- I REVIEWED BY------------------------- - _ ------------------ DATE--- ------------•- BUILDINGPERMIT ISSUED--- = -------------------------- --------------------------------------------- ------------------ DATE------ -- ---------------------------------------- Alterationsand/or-recommendations----------------------- ----- -----------------------------------------------------------------------------------------------------•-•----------------..------- r �.--------------_._-.__-------._----_----------__.._...__-----..-.-`-'...____...-------------------------------•-------------•------•----------------------......-----------------'------_------•-.-----.___________.._. r J r . FINAL INSPECTION BY--- -'-- -J----- ----- --- .... ---- --- Date.. - tf ------------------------------- 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 '