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APPLICATION FOR SANITATION PERMIT Permit No.r (Complete in Duplicate) Date Issued -----4S- ., r San Joaquin Local Health District for a permit to construct and install the work herein described. Applicakion is hereby made to the S q This application is made in compliance with County Ordinance No. 544. - ' JOB ADDRESS AND LOCATION -------1-71.7 ------ Phone - Owner s Name_______ _ _________----------------- L - 1_T Address. - Phone---------------------------•------- Contractor's Name ------------------------------------- --- -- - -- -- ----- --=-------- El lnstallation will serve: Residence Apartment House ❑ Commercial F1 Trailer Court ❑ Motel E3ter Number of living units: __�__ Number of bedrooms__ Number of baths I--- Lot size Depth to Water Table ---k�t• Water Supply: Public system cg. Community system El Private ❑ p a a Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand F-1Gravel F] Sandy Loam F-1Cly Loam ❑ Cly ❑ Previous Application Made: Yes ❑ No F__New Construction: Yes [&_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y _ Septic Tank: Distance from nearest well_________________Distance from foundation------------------- ❑ �d�e�o Cif compartments------------- "----- --, Materia______._____.__________ _---------------------- --Size----------------------------•---Liquid depth--------------- ---------Capacity---------- ------ - Disposal Field: D' nce from nearest well__==.-_::::::.::DLength offrom each I ne foundation--==--------------:Wsdth ofttre chnearest lot line__."---_---_.---- ❑ um r of lines____ " Total length___ Ty e of filter material_ _..____ _______-Depth of filter materia __._._ ._. "-- istance from foundation---;9_0""."-Distance;o nearest lot lme_. .--�- Seepage Pit: Distance to nearest well... 'LC..D 3-Z , De t'n___.__o�r�-------------- Number of its.-".- Lining material_-"--oe Size: Diameter___-- p p -- Cesspool: Distance from nearest well-----------------Distance from foundation..__._-____.__. ?Lining material_____._______ els. Depth----------------------------- - --------------------Liquid Capacity---------------------------g ❑ Size: Diameter----- ----------------- - ________________________Distance from nearest building_.____.._----------------------- Privy: DistancE from nearest well_"_."................ . _ ❑ Distance to nearest lotine..._.._-._----------------------------------------------------------- ----------•---- ------ - --------------------•----- ---------•----------•----•---- Remodeling and/or repairing (describe):- ----------------.-- - " -------------- 3 -----•------- ---•---- -------------------------------- -------- and - - - ---•---- - -----•-- ------ ------ ---- ---- -- ---- -" that wo wi I hereby certif wsh andh ulespandaregulahis tions olf tation he San JoaquinhLocalkHealltheDistnct� accordance with San Joaquin County ordinances, State laws, - -----------------------------------((Owner and/or Contract O or Signed -- ------ ( ' ) ----- --- --------------- __ Title------ ----------'------------ ------- By:-_ -- - -- 5, t . { 1 (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY F�� ------------------------------------------------ DATE---e------------------------------ ------------------- APPL1CATlON ACCEPTED BY -------------------------- REVIEWED BY------------------------------------- ------- -.--- ----------------------------- - DATE__.. -----�.- ---------------- DATE" -------------------- ------------------ BUILDING PERMIT ISSUED_____"--------------------------- • -------------------------------------------------- ------------------ --------------------- Alterations and/or recommendations:_------------------ ---------- ----------- ------- ------------------------------------------------------ -------------------------- ------ -------2 ----------------------- --- Date----- ----- - FINAL INSPECTION BY:...._"-_ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT • 300 West Oelc Street 132 Sycamore Street 814 North "C" Street t30 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E.. 9. 145446 ATWOOD _