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APPLICATION FOR SANITATION PERMIT Permit' No. ... ...... (Complete in Duplicate) Date Issued Applica,ion is hereby made to the San Joaquin Local Health District for a permit to constr and install the work herein described. This application is made in compliaiice with County Ordinance N . 549. Health u is r ic, for a permit to constr , 13 9, Ordinance N 54 AND JOB ADDRESS AND AT ------- - ---- ----- - --- --- ----------------- s N, ... ...... . . . .......... Owner's Nam ---------- ---------- ----------------------------------------- Phone------ '/ i Address hone------ Address. ..... - ------ -----------------------I---------------------------------------------------------------------------------------------- ------------------ Confr cfor's Name i=T-er------------------------------------------------------------------------ ----------------- P h o n e �7/.,P--6-�_ _ Installation will serve- ;Resiclenc�.� Apartment House 0-. Commercial [] Trailer Court E] Motel F] Other ❑ Number of living units: Number of bedrooms-.:?-- Number of baths A�__ Lot size ------ ,5��-- ---/_-.O- ------- ----- Wafer Supply:--Public system^ Community system 0 Private 0 Depth to Water Table55_ff. Characfer-of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Ej Clay Loam E3 Clay E] Ad Hardpan Previous Application Made: Yes F-1 New Construction: Yes No El TYPE OF INSTALLATION, AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 f i eet.) L I f eptic T k* Distance from nearest well_________________Distance from foundation____.____-__-___--Material___-__.___-_-___________..._____.___.._ No. of compartments.......... -- - ----------Size--------------------------------Liquid depth------------------- -----Capacity ---------- fi ------------------ Disposal-FFi,/d Distance from nearest well--- - --------Distance from foundation--------------------Distance to nearest ]of line___..-___ r ----- Number 01 lines-----------------------------------Length of each line_-----_------------- --------Width of trench---------- ------------------------ Type of filter material___----______.__._-____Depth of filter material_---..__.___.._-____.Total length---------------- -------------------------- Se a e Pit: Distance to nearest well ---Distance from foud ti _/,�.>...�....Di-5fance to nearest lot line_. Number of pits.... 6__ _ r), a ion-_ ------- - Lining material Size. Diameter__.___17-------- ----Dept h------J*r Cesspool: Distance from nearest well-----------------Distance from foundation--'-----------------Lining material___._______-_-_.-- -1----------------Liquid Capacity--------------------- 4j ---------- le A Privy: Distance from nearest well______________________________ _____ -------___Diisfance from nearest building------------------------------------------ 6' El Distance to nearest lot line_______________________- Remodeling ine--- ---------------------RemodeNng and/or repairing (&scribe):____ ------------------ -- ---------- ,00_,._0 ---------- ----- -- ---------------------- 01 ------------ ------------ -------------------------- ------------ - --- -- - -------- ---------- ------ ---------------------*------------------*----------------------------- --.1------_1P- - - -- ------------ ------- - Cr 7" f --- ------ ---------------- ------- --------------------------------------------------------------------- -------------- -•----------------•----------------------------------------------------------------------I--------------------- ------------- ------------ -------------------- I hereby ce ify that I h e prepared this application and thai4he"work will be done'in accordance with San Joaquin County ordinances, State la an Ul la' �d-regulaf; S q4 the San Joaquin Local Health District. (Signed)_ ---------------------------------------------------------------------------------- wner and/or Contractor) By:------------------------------------------ ---------------------r-------- ---------------------------------------- - ------------------- (Plot plan,:showing size of lot. 1 cation,of system in relation-to wells,'buildings, etc., can be plat� on*rUsee side). -.0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - --------------- - 5 ---------------------------------------------------- DATE_—----------- ------------------------------- ------- --------------------------------- REVIEWED BY t�----------------------- -----;;------------------------------------------------------------------------ DATE---5:�: BUILDING.PERMIT ISSUED --- -- ------------------------•----------------------------------------- --- ----- -------- DATE....... -------------------- Alterations and/or recom`me�w'dafiovns�__-----------_------------- ----------------_------- 1 4 ------------ --- ---------------- ---------qe% 11 1� I __1 ---------------------------------------------------- --------------------------------------- ---------------------------------------_---------- --------------- ------�') - _ - i - ------------------------------------------------------------------------------ I b - ----- ------ -------------------------------------------------------- ------------------------------ .......... ----------- .... ----------------------------------------------------- ----------------------------------------------------------- I--------------------------------------------- ---------------------- ------ -- I------- ----------------------------------- ------------------------------------ ------------------- ---------------------- ---------------- ------------ ------------- ---------------------- ------------------------- ---------------------------------------------- FINAL INSPECTION BY:-.---, ------ ------ Date-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 .Wesf Oak Sfreef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California vor .1454•'6 ATWOOD 12-54