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�•�,...: ..... - ----- APPLICATION FOR SANITATION PERMIT Permit No. ---• (Complete in Duplicate) Date Issued __-----01'_� pion is hereb made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. Applica Y This application is made in compliance with County Ordinance o. <`7[ - --- -------------------------------------------------------------------- - JOB ADDRESS AND LOCATION------ -------- .•--------------- • ----�-- - ------ - Phone-- ------------------------------- N ---------------------- • -------1--------- Owner's ame_ ----• - ..--------•-------------- . ------------- -------- Addressone Contractor's Name------- Trailer Court ❑ motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ -- Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _-ter_—____-------___ -------------- - Water Supply: Public system El Community system C3 Private�Ep th to Water Table. P ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4_1481dpan ❑ Previous Application Made: Yes ❑ No ew-Construction-- Yes e—No--0, .�a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / L''tl ! Q_------Matevial --- ------------ ---- -------- -• Septic Tank: Distance from nearest well--116 ._.._._--Distance from foundation___ � Ca acit _0------------ Li uid de th--- -- -- ------ P Y No. of compartments.- ---�... ------ -.Size---�--f�---�fi -�-- q P• r` Disposal Field: Distance from nearest weIL�Q._- --Distance from foundation----�-p--------Distance to nearest lot Gne__�----- P� Number of lines------.r___.--� Length of each kine---- ---�►-- ---- .Width of trench----- -=----------------------- O0 I Total len th --C7-------------------- N Type or filter material.-- of filter material.__.-�_ __._ g Seepage Pit: Distance to nearest well------- --------------Distance from foundstienDiameter__.Distance to nearest lot line pth -_-=---::_------ S ❑ Number of pits----------------------Lining mate ing Cesspool: Distance from nearest well----------------- from foundation.-_----- Liquid Capacityt _____. "-gals.P ❑ Size: Diameter----------------- -------- ------ ---Death-- -------- ................................ ------ q - ----------•------------ Distance from nearest building---------------------------------------- Privy: Distance from nearest well---------- --------- --------------- --- ------------------- -------- ❑ Distance to nearest lot line--------------------------------------- Remodeling and/or repairing describe):-------------------------------------- -•-------•--------- ---- I hereby certify that I h anadlf the San Joaquin Heawill l heDistr District- accordance with San Joaquin County rules and re ordinances, State laws, and guiations o (Signed)--------- =-.'- ------- ------- - --------------- -------- ------------------------(Owner and/or Contractor) - '` 'Y-�_.�_.:} :�,-.�-� Title (Plot plan, showing size of lotlocation of system in relation to wells, buildings, etc., can be placed on reverse si e. , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B .___---- -------------- ----- DA ------�c3-------- - ------------------------------- - ----------------- DAT - REVIEWED BY ____________ __ ------ DATE----�---- -� --- ...---- -----------• ------------------• BUILDAlterations and/or recomme ING PERMIT ISSUED ---- ---- --------- ---- •------. V � ------------------------------•---------•-t -------------- �-�2r. .�a �-- ---- ------------------------ -+-- ---------�--- .e Date----- --- --------•--- FINAL INSPECTION BY:_.._:...._1--------•---- ------ - - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C' Streef 13o South American Street 30� West Oak Street Trac California Stockton, California Lodi, California Manteca, California y' ES-9-21A 145446 ATWOOD 12-54