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. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 r�- Date Issued r Applica{ion 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 County Ordi ante No. 9. JOB ADDRESS AND LOCATION-•---- / - `s "'r----------------------•------••-----••-------------------------------- Owner's Name f^ `" ---------------------- ------ Phone------------------------------ Address---------- -----------------------------Address---------- '°----- ----- ------------------------------ ---••--------------- Contractor's Name---------------- it- - - ---- _ ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: --k—Number of bedrooms __'Number of baths __f___ Lot size -- --_ -----------------------' a Water Supply: Public system A- Community system E] Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6--Inardpan ❑ Previous Application Made: Yes ❑ No [P'" New Construction: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e;Spti- Tank: Distance nefm nearest well-----------------Dis ance from foundationMaterial-__------ .Nocompartments _ __ ' uid depth-- Capacity__.__ _- ._ -------- is os iel Distance from nearest well...........------Distance from foundation--------------------Distance to nearest lot line-_---___•-______- ' Number of lines----------------------------------Length of each line-----------------------.------.Width of french------------------__------------.- 44 - Typo of filter material-------------------------Depth of filter material----------------------- length-_._________________.__.__________________ r (} • Seepage Pit: Distance to nearest well_.� �._Distance from fours tion___ _-_____ istannce to nearest lot ine___ ___________ Number of pits.------r------------Lining materiale� -&ize: Diameter_ ------- -----Depth-----_W5- ---------------- ' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__________._______._____________--- Size: Diameter----------------- --------------------De th------------------------------ ---------------------Liuid Capacity gals. Privy: Distance from nearest well------_-----------------_----------.-----------._Distance from nearest building--------------.------------------._______- ❑ Distance to nearest lot line-------- ---------------- ---_....... ------------------------------------------------------------------------ --- Remodeling and/or repairing (describe): rxt -- ��t ----------------------------------------------- -------------------------••---------f--------------------- - ---------------------------------------------------------------•--------------------- ------------------------- ------------------------------ I hereby certify that,1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. I .. ---------------- (Signed) s Contractor) ----•--•--- �- -- -- X BY�--------------------------•------------ - - .---- ,..------ ------y--------------------------------{Title)-- -------------- (Plot plan, showing size of lot, I ion of system in relation to wells, buildings, etc., can be placed on reverse Odie). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -- ---------------------- ------------------------------------------------•----•--------- ------ DATE---------------------------------- ----------------- ` ------------------- - = DATE REVIEWED BY------------------------------ BUILDING PERMIT ISSUED----.------ DATE-----QJ% ----------------------------------------._ Alterations and/or recommendations:------------- -------- •------•---- -------------•-• ---------•----------•--•---------------------------------- �p 4 --- - - -`-'rte`--- ---- -------------------------------------------------- ----------- ------ ------- ------ - - --------------------------------------- { FINAL INSPECTION BY------ ---- ------------ ----------------------------- Date_- --__- y--�._ ------------ 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 r!3-9-2m 145446 ATWOOD 12-54