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�1 APPLICATION FOR SANITATION PERMIT- Permit�jv (Complete in Duplicate) Date Issued1 �-- 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. 54.9. JOB ADDRESS AND LOCA 10 --- --- -------- /.., _ -- ----------------------------------------------------- ---------------- Owner's Name------�,�/�--- -------------------------------------------------- - ------------------------------------ Phone Address---------- , -------------- Contractor's Name_______________ ------- ---- ��' ------------ --- ----;� - . -f..�2.��-:��,-� Phone-�--------------------------- R3---Apartment ❑ ❑ Trailer Court Installation will serve: Residence House Commercial � ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms A__. Number of baths - --- Lot size �- _._f _�_____. ------•---------- Water Supply: Public system Community system [I 'Private [-] Depth to Water Table ft. Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe Ej-`hardpan [] Previous Application Made: Yes E] 'No ® "New Construction: Yes [-] No "' TYPE OF INSTALLATION AND SPECIFICATIONS: f o septic tank or cesspool permitted if public sewer is available within 200 feet.) epi ,max r an� Distance from nearest well______________y__Distance from foundation--------------------Material-_____________--_---____________-_--____________. No. of compartments-------------- - - Size-----------------------------------Liquid depth.- -----------------------Capacity--•------- i osal Field: Distance from nearest well__A4 _.. _.Distance from foundation__f �.____-__.Distance to nearest lot line-__� Number of lines-_------- -- ...._____._____ -Len th of each line___---- trench d g --._.____.____.._.Width of ....._•- Type of filter material__/, A_7- fj ,y-. - -Depth of til}er material_._._4--_.____Total length______ --_------ --------------- i ` - �q eepage Pit: Dis#ante to nearest well.... nce from oun ion_ _ _______ t Ilia to nearest lot liner _-___-- �' Number of pits___..--------------Lining ma erial-0r4_ . ._.Si e: Diameter---________..___Depth------, �`'____.______.___.____ Cesspool: Distance from nearest well_________________Di tante from found ion----------------- Lining material--------.------_____.__ ❑ Size: Diameter--------------------------------------Dep --- --------------------Liquid Capacity-.--------------------------- gals' Privy: Distance from nearest well-------_______ _ -------------- Distance from nearest building__-_---_--__.___--______ ❑ Distance to nearest lot line Remodel'mg and/or r pairing �d scribe ',-; / -----------a4r, ............ , ------------- -- - ------ -------•-----------------------------•---------------------------•--------------------•-------------------------------------••--------------------------------------•-------•------•------------ --------------- 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 rules and regulations o the San Joaquin Local Health District, � � y t - (Signed) '- °-- - ==-' ----------- --------( c.Contractor) I $y:--•-----------------•-------------;` 1 --------- ------------------------(Title)----f � '��1----------- (Plot plan, showing size of lot, ion of system in relation to wells, buildings, etc., can be placed�on revers�ide). \` FOR.-DEPXkTMEENT USE ONLY 1 ------------- _ �... - APPLICATION ACCEPTED BY-- ----- ----------------------- - - •-------•---- DATE---- . REVIEWEDBY ------------- - - -- - -- - - ------------------------ ------------ DATE----------------- • BUILDING PERMIT ISSUED---------------•------------------------ - - DATE----------- - \� , Alterations and/or recommendations: l - ` ----------------------------�"-��'�/)'•---r-- --- ----- --- --r----X. ------------------- '----------------.--------------------------••-----------------------------------=�--------------------•------ \J --1--�r------- -------- - --- \II --------------------------•---------------------------•------ ------- _ + -----------------I--------------------- --- ---------------------- FINAL' INSPECTION BY: = Date ----------------------------- SAN -------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 132 Sycamore $free! 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-21A 145446 ATWOOD 12-54