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rt _. / APPLICATION FOR SANITATION PERMIT � Permit No. ...!��u__��~ (Complete in Duplicate) d Date Issued .- -- � -- Application is hereby 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 Co nty Ordinance No. 549. � JOB ADDRESS AND..,LO ATION.... ..... •___ - -/ �/ �• ------------ ` Owner's Name___ _ ___ _ _ ________ _____ - ----------------------- ------ Phone--------------- Address.-•--!5• •-- Contractor's Name______ _ ______ _______ h j Installation - Installation will serve: Residence Or Apartment House ❑ Commercial ❑ Trailger Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths Lot size ------------------•- Water Supply: Public system A—eammunity system ❑ Private [❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ^`Gra el ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 6--•Pdew Construction: Yes _ TYPE OF INSTALLATION AND SPECIFICATIONS: [No s,_p!'LC.fank or cesspool permi#ted,if.public sewer,is available within 200 feet. Septic Tank: Distance from nearest well��—f- Distance from foundation__t__- -__. �� -----.Material------------- --------- ---------- ----------- �..P- No. of com artments__-__. Size_ 4 p --- --Liquid depth-- Capacity--? r Disposal Field: Distance from nearest welif�i'iy,�-cDistance from foundation-.-_f-_b!.-----Distance to nearest lot �- Number of lines---_----El_-...__ Length of each line___. -----..-.Width of french.-_�-�Y f --------•--------- Type of filter materiaf.__/ _-4__,_--_-_---Depth of filter material-------- ---.Total length-------- ---------------------- Seepage -_----Seepagege^Pit: istane rest well.------ Disanteom foundation----Z-0--i----.Distance to nearest I t iiNumber of pits • g -_-,.-Size: Diameter2i.______... Dept'sr Cesspool: Distance from nearest well-----------------Distance from foundation-.____"------------Lining material_-. __-___ _-- — _�_ ❑ _ Size:.Diameter _ - Depth------ -- _-- ------- -- --- Liquid Ca.paijf Privy: Distance from nearest weft.........:--------------"------------------------Distance from nearest building ❑ Distance to nearest lot line-----------------------------•---------------------------- � w` Remodeling and/or repairing (describe):_.__ ------- I-------------------•------••----------- �.�C ------------ --------------------------- r `. -----•------- -------- � ---------------------• --------- --------------� 1.._ s . f - ----------- -- ------•------------ ----------------------------- --------•---------------•- ------------------------------- I hereby certify that I havg prepared this applicaion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -� _- ---------------- **r(AD wfter-en4/,or Contractor : rile)------------------•----- ------------------------------(Plot l , plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ---------------------------- DATE_ ? �A... "? REVIEWED BY. BUILDING PERMIT ISSUED b -- -------------"--------------- -.--- DATE----------- r--- - -------------------- ----------- ----------------------------- -------------- ------- DATE Alterations and/or recommendations_________------ --------------------------------- •---------•----- F ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------•------------------------------------•------- ------•----------------------- ------- ----------- FINAL 1NSPECTIO I ----------------------------�Z------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ' i 9-2M 145446 ATWOUD 12"54