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f. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued __-y1x/jZ__ Applicai-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 o. 549. JOB ADDRESS D LOCATION_.-_____-S-,..,bor S ------------------- -- �f Owner's Name---------Tx-__ - ---E`_� '�R. -•---------------------------- -------------------------------------------- hone. _ _ Address-------•- Contractor's Name Phone Installation will serve: Residencelj�__Apartment House J] Commercial [I Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ' � Number of bedrooms ----`_._ Number of baths -_ L ot size 15_b___NV ___i_-Y --------------•-------- Water Supply: Public system`� Community system E] Private El Depth to Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑-Clay,.❑ AclobQ<,,Hardpan ❑ Previous Application Made: Yes ❑ N0 New Construction: Yes N0 ❑ TYPE OF INSTALLATION AND SPECIF'IIC\ATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- _ _ . Distan e from foundation---Jl_Q---------.Material __ _ ... ----- -- - No. of compartments________ __ __ _________Size____ y,� = Liquid depth ---- -----------.Capacity. Disposal Field: Distance from nearest well,Foot - Xi.• istance from foundation---,�0__-____._,Distance to nearest lot ine------ ----__ Number of lines_________ ___ _ L th of each line------L_aWidth of french.-_� t� Type of filter material_ _.. length----- Q Ite material--------J--4- - _---To#al --j 4---®----------------- r . Seepage Pit: Distance to nearest-well- --------------------Distancefrorn foundation-------------------Distance to nearest loft line__.__._.._:____._ Pits ---.--Lining material------------------------ Number of its.--- --------- ize: Diameter------------------------Depth--------------- ------ ---------- esspoo : Distance from nearest well________________ Distance from foundation-------------._>(_._.Lining material---_-----------__-__._ ❑ Size: Diameter_____ _____ ____ ___ - --------------.Depth------------------------------------------------4---Liquid Capacity-- --- gals. Disfance 1rom-,nearest-Welk_=:.-^ a=' t---„ ,�=.�R = -s� ____ _______ _Qistance frorr,`"nearest buildi�ig.__. Distance to nearest loft line_____________________ -------------------- ----------- Re tlelin"g and ar e air, ribe]:_._. / ------ •----•----- ----- - --o'✓ - ------------ - ---- -- ----------------------•------------------ -------------------------------------------------------- ---- . -------------- --------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,, S�ta�t laws, and rules and regul.tions of the San Joaquin Local Health District. (Signed).. --- ••-------------------- ------------- --------(Owner and/or Contractor) By:-----------------------•------------------•------- Tale (Pl ------------ - ----------- ----------------- -------- o p an, s owing size o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ARREEPPLICATION ACCEPTED. BY.-. . Y ---------- DATE ------ ---------•----------------------- IEWED BY ----- ---- - - --- - - ---- - DATE ---•-------------•-------------- BUILDING PERMIT ISSUED----------------- ---- DATE----------- '. Alterations and/or recommendations:_.._. .. ----------------- .._ —--------- --- -- -------•-------------------- ------------ - ----- ---- - - -- FINAL INSPECTION BY:-.----; - ------- _---- Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ . 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9 149446 ATWOOD