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APPLICATION FOR SANITATION PERMIT Permit No. ..... - (Complete in Duplicate) AIX\—..._.�,. , w..— . - pate Issued �/-" � S-� w .... .. ..,:.: ----- 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, ff JOB ADDRESS AND LOCATE N = =.asr o� -----2 . S..-.-� 7`-- ------gw�� / Owner's iNam-e_------ 1 .-..—. '� f./ = -- -- -�------------------. ti t b . ---- . ----• - hon - !� Q Address--------------------Contracfor's Namef1.T ----- --- - • -- _�---:- �------- -------- Phone----•----------------------------- Installs#ion will serve. +Residence , Apartment House ❑ Commercial ❑' Trailer Court ❑. Motel _ Z ❑ Other ❑ Number of livingunits: _ .__� Numberof bedrooms _--'___ Number of ba i�s 1 � k baths -�----- Lot size ----•--`��------ {i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth.of 3 feeti ;Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑' ClayAdobe Hardpan �- Previous Application Made: Yes E] NZ 2� New Co sfruction: Yes ` No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS�'%, (No septic tank or cesspool permitted'iif public sewer-is available within 200 feet.) Septic Tank: Distance from nearest well_-``----Distance from foundafion_A_ .___-MaterMaterial---- V-101 _ — q ________________ ___________�No: of compartments -------- ( Lid depth___________ _ --__ ------ Capacity----- ---- Disp s I Field: Distance from nearest well. - Distance,frorn'foundation---__--�� -----Distance to nearest lot line-------4�-_- Number of lines-------- -------- Length of each line-----------Ob---------.Width of french_----•----•- �•r Type of fitter materia!-_ _- , -_ _ Depth of filter material______ .__._--AL -Total lengtO------------ :___, � Seepage Pit: Disfance to nearest well_.__.--_--___.-------Distance from foundation___--a`rDf Distance to nearest lot line_-_-_Z_a ❑, Number of.pits--------/-----------Lining material---------------------- Size: Diameter.; '3 Depth- 2` -------- rr\'' Cesspool: 4Distance from nearest well-----------------Distance from foundation------- 'Lining material___________-_._____._ W ' F1 -Size': Diameter Depth-=--------------------------------------------------1iquid Capacity,----------•---------••-----gals. Privy: Distance from nearest well_.__..__________ --------------------- building� �- -- ----------------------•-- Remodeling and/or repairing {describe):---------------- ---------------------------------------- - ---------------------- -------------•..................-------------•--------------•-- ---------- ---------•------------- - ------ - --- - ---------•--------- --------•---------------=------------•---=-------•-------------------•------------�-----------=--------�----------------•---------- . t -f,- if hereby certify`th'at I have prepared fhis application and that the work will be done es anin accordance with San Joaquin County ordinances, State laws,and'ruld regulations of fhe San Joaquin Local Health District. fA (Signed). '•'•• f- rand/or Contract t `By ' - ----------------------------- --------------------------- ) �. f (Ownsor L(Ti#1e) -----------`•-- ---------------------- Plot Ian, showin 7 ( p g size of lot, location of system in reflation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 5 APPLICATION ACCEPTED BY--------------3------ -- DATE__.----- - - -------------------------------------------------- f REVIEWED BY ------------------- - DATE-,-.- ----- ` -------- • ------------- $UlLDING PERMIT ISSUED --- DATE_ -------- -.--------------------------------- .................. Alterations and/or recommendations;---------- ........ t. -----•------•--- •----------------------------------------------- - _ ....---•-----------•-----•------------------ C.. l--- - - .................. -------••--------------•--------•------------ ---------------------------------------------------•-----•------ -----•-•---------------------------------------------------- -- -----•--•---------------------•------------------------ -- s . ia FINAL- INSPECTION 1k,1S. -------•--. - Date ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca. California Tracy, California i CS--9-2M 145496 ATWOOD 12-54 f