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(A APPLICATION FOR SANITATION PERMIT P. .-t No. (Complete in Duplicate) ------- .......... A Date Issued --- A A pplica-lion is h!re6y 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 No. 549. JOB ADDRESS AND LOCATION -------- ------------------------------ ------------ ------------------------ 15 Owner's Name---- P-�u ��l S fg ........................................ --------------- ---- ---------------- ------_-----------.-. Phone Address---------- Contractor's Nam t- -----_-_ --------- ----------- o V,19_1_10 _/P) C -------- n ...5&-------- -------------------------------- -------- Installation will serve: Residence ...... Phone.z�� Z7-�'6��_7--- a Apartment House E] Commercial 0 Trailer Court E] Motel El Other El Number of living units: --/---- Number of bedrooms -:2- Number Of baths ----f--- Lot size ------- Water Supply: Public system :1�1 ./\--/--------------------- Ir Community system El Private �oaDmepth to Wafer TableNew Construction: Yes El NodpanPrevious Application Made: Yes El ' No 0 ❑Character of soil to a depth of 3 feet: Sand 0 Gravel Ej Sandy 0 Clay Loam 0 Clay [I Adobe Har TYPE OF INSTALLATION AND SPECIFICATIONS- (No I septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-- from nearest well compartments ----------Distance from foundation-------------------Material-------------------------- --------------- ---------------- _Size"-------------------------------Liquid depth,---- Capacity.. Disposal Fiel Ace from nearest well-___.._ ------------ --- -----------------_-- um ----------Distance from foundation---- Disfance to nearest lot line of lines_____________---------- Length of each line------- V -------- i- Type _;,.,-_-.Width of trench---.. Seepage Pit: Distance to nearest wefl r material-----/-;�-- ---------Total length------- ------------------------ Of filter material--- Depth of filf�� Number of pits. stance from foundation--- to nearest lot I' ------/----------- Lining materi\l__'0n ine-.--- a _9.1_'�ize: Diarnefer___�? --------Depth ------------- 'Cesspool: Distance from nearest well-------------- --Distance from foundation. ------ EJ Size. Diameter----- --------------------Lining materia -------------------------- ------Depth_.--------------------------------------------------Liquid Capacity.-material___.__.....__--"_--_ ❑ Distance from' nearest well---------------_-"__---"__- .--------------------------gals. ............................... _Distance from nearest building__________________ ❑ Distance to nearest lot line S ------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe): --------------------------------------------- - -------- ------ --------------- --------------------------I------------------------------ -------- --------------------------------f--------- ___.- -- ---- -----------I-------------------------------------------------------------------------------------------------------------------------im , ----------------------------------------------------------------- --------------- ------------------------------------------------------------------------------I---------------------------------------I I --------- - - ---- -- - - - ------- -- --- -- ----- ----hereby certify that I have prepared this application and that the -------------------- --------------- -------- -------------- ordinances. State laws, and rules and work will be done in accordance with San_---Joaquin C-o`u�nfy_ regulations of the San Joaquin Local Health District. (Signed)____-__ -- ------ -------------------------------------------------- -------- .......(Owner and/or Cont-ra By- ---- ------ (Plot plan, showin Z f t, -------------•------------------ --(Title ------ ----------------- 9 size 0 lo location of system in relat;on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�_._ REVIEWED BY ------------ D A T E�:,7-------- BUILDING PERMIT ISSUED --------------- DATE- --------------- ---------- -------------- -------------- DATE.-------tl 1\ Alterations and/or recommendations:___----_--_-- --------------------------- ------------------------------------------------------------------------------------------------------------ -1----------------------------------------- --------------- ------------- ------- ----------------------------- --------------------------------------- -------------------- ----------------------------------------------------------------------------------- -------- -----------------------------------------------------I--------- -------------------------- ----------------------------------------------------------------- ---- ------------------- ------ --------- ------- -------- --------- -------------------------- -------- -------- ------------------------------------ ------------------- ------------------- -------------------------------------------------------------------------------- --- ---- -------------------- ---------- -------------------------------- ------- - ---------------------------- ------------------------ FINAL INSPECTION BY:..-. ----------------------- Date--------� 6 -- 7%-�A�- --------- --------- .......................... ..................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amer;cen Street 300 West Oak Street 132 Sycamore Street 814 North 11C,, Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54