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APPLICATION FOR SANITATION PERMIT Permit No. _P, �.. (Complete—�n Du lica . Date !s uedA0 --- Applicaklo�"is her`.eby Fri�adei f'o tha San�.loayuin Locwal E Eealth District for a permit to eonstruct ari s' the work herein described. This dPplicafion+is.rb6 et an-corhi .liance with County O�in'ance;.No. 549: JOB QbRES -MID ¢ . S GATlON --------------------------------------- r-s� Name J - _ 4 Phone,- Own -- - trj • Address:... r= r 'r ------ •• —T' .r ?----'------------ --------�--`--- ------------- ---------------- - ------------------ w ^---------- ------------ Address." ---------- f '_ Contr�acfor,s .f`lame f _---------- - i ' -..:_...= Phone ----- �,, lnsfallafion wi l�se ve Residence p [] - ❑ : r Court 0,' Motel+0 Other ❑ A'artment House Commercial --------- Trailer Numbor of diving Tuni4s ! � :" Numfeer`of bedrooms J. Number,of-baths �._ Lot;size ��j' 4?__J� _ C _-. ' Wafer=jSupply ;Pub7ic systeComrnunify systerri ❑ Izrivate ❑ 'Depth to.Water Table. • ,.., d.. Gravel ❑ Adobe.❑ Hardpan ❑ Character af.-soil }o-a_ ep}h_o{3_feet• San ❑ 0.i Sandy Loam ❑ CIay:Laam ❑ Clay Previous Applicafion-rade:•-Yes--❑- No.['� New•Construction: Yes 14- No ,❑ ¢ 4 1 + +. 1-r : i' -j - • - fi:is 1 4- TYPEOIr INS:TALLATIOi�J-;A>�!fl SPECIFICATIONS r -( s eptici-tankiar.Icesspool permitted if public sewer is-available within 200 feef.) 1 M� p Tank` r . --Distanc' from:-nearest wellrr��r Dist nce from fa undation__J..(� 1_______.Materral_ ____ _._._. .' Se tic" _ r p :. quid depth` Capacity C°i Q No._of com artmerits_ Size _ Li Disposal Fields ;s-Distance from nearest weE! �� D.istance from foundati n... .E2 Distance ta'nearest lot line:.:.. ......... jj Number-o{ lines: ------ ngt! of each Ime.__- (�_.__ Width of trench._ __ _________________ y' 1� 7T-* Type oi;filter material filter material Tota! length '-" 5eepagelPrt: Qistance to-nearest::well ;= Distance from..foundatiori................Distance.to,nearestJot lire-----i_ r ++ ' pits.!.. g :_ .Size Diameter _A k. ` Depth --------------------------- i = - rom' r -i - T ti , rfoundation . :. .Lining.maferial O Number of its.' ` Linin material ' Cess ool . Distance from nearest,we}! Qrstance f ❑ ' * Size Diameter -i - '. 'Depth ` r . -_Liquid .Capacity ___________�_"gals. t -� +, , 1 I- - Y '—n' t r r — Privy YDistance.trom;nearest well "._.. ..... .I Distance from Snearest buildin'g _____.____'......... ---------- s ........ sancto iesrstoe ---------------------------------------- El -❑ n - ` ------- ---- ' f t - 7 t I 1 b Remodeling and/ar'reparnrig (describe) -; a - s , • J ! - - I.-hereby•certify-that-II have•preparedthis application'-and Aat-the-work-Will be done in-accordance with San-Joaquin County . ordinances, State laws;'and'rules and'r`egulafions'of'the San'Joaquin Local_Health District. r r T (Signed) " '__'_ __.___ r ---- r --ry ---y----- ------ _. . ""__-_r.__". 4 -4 - c {Ow1ner a ,d/or S Contract or)" $y= '-------------- ------------------- - -- `------------------'-== { i le]:- ----------- •------------------- -- -- ---- (Plot plan..showing.siieoff,W. location-of system in relation to wells,'6tildings,'etc., can'be.placed on`reverse side].. FOR DEPARTMENT USE ONLY f,..+ APPLICATION ACCEPTED.BY.__. _. - -- QATE_ ---:��__-•-__.--- .---------_-__--- ---____-- ------------------- ---- -- `----i }"-- D REVIEWED BY -------------------------------------------- I = i t o y r ATE = �,/ BUILDING.-PERMIT ISSUED"_= DATE _ _ ,. x . . „. Alterations and/or-recommendations , ,, �. ---------------------- - i, .. . •t ail' # . t o . - ------- ----- - ---------------- -- •-- -- r �o .�- y r. --•----- J t t 1.. , <- - i `� -,�` 1 F1NAL~'i'NSPECTION BY:. ` _; --"`,---- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streaf 614 North "C" Street Sfockton, California 1 Lodi, California Manteca, California Tracy, California ` — FS--9-2M 145446 ATWOOD 12-54