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APPLICATION FOR SANITATION PERMIT Permit No. ?llt_& �----------- (Complete in Duplicate) Date Issued ___ _. Applica4-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 i h County rdce No. 549. r4--------•-------------- --- JOB ADDRESS AN L C ON-_.... --------- . lLhB- - ------------------------------ - Owner's -------1, ------------------ --- -------------- Phone I ----------- ------------------------ ---•------------ -----...------------------••-----...-•----_.. Address._..-Na?Ar ° HApa ------- -------- I-(------------ Name--------------•--•------- ------------------------------ Installation will serve: Residenceet House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ �Other,�❑,, l Number of living units: _�_ Number of bedrooms .. Number of baths ._ Lot size ____ __.-� /---`"' ------------ Water Supply: Publi�'system ❑ Communifiy system-❑ Private Depth to Water Table .. __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan Previous Application Made: Yes ❑ No New Construction: ,Yes No ❑ w J fi TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance.#rom nearest well-----------------Distance from foundation---- ---------------Material------'-------------------------------------<_, '1 No. of compartments--------=-------- ------Size------------------------•------ Liquid depth Capacity D ❑ f nce from nearest well..._ Distance from foundation................__.Distance to nearest lot line_-.-._..__-_----- Disposal Field: Dista Number of lines---------------- ------ ----------Length of each line----------------- ------------Width of trench----------------------------------- ❑ Type of filter material-------------------------Depth of filter material-----------------------Total length_----------------------------------------- i ------•-------------------•------ ----- , ,... i .4 Distance to nearest lot line_-_-..-__- _ r Seepage Pit: Distance to nearest Wel!_.....-- _ "_.Distance from foundation .............. ..... Depth Lining material-----------------------Size: Diameter------__------. ❑ Number of pits. ----�:----- ------ . ? 'Zo .meq material-------- - ------------ Cess ool: Distance from nearet wel .__ �_-.Distance from do Liquid Ca acit ®........._.gals. h- - _ _ ftelSize' Diam_eter__" ��' --- 4 Depth ' - # s D g p ,M- s:, _ ,� res ---- ------ ' = - stance from nearest building. i D' Privy: 4 _ Distance from nearest well----- __-- ---- --- r ❑ Distance to nearest lot line.._"':--;-------------------------------- -------•-----;•---- ----••----... - ------------- ----- � - i '�-`- -•`--Lam--�'---�`-'-'--�',�c�+!-�!f,C.•_i�J:- �►r2:,�r�f---�'�J''�f---''�-�----•----------------- - ----•-�---�•�-'--�'�'�• 'x'�. Remodeling and/pr repairing (describ ):._`_. --------------- ------- -til'--••- A I-hereby certify that I have prepared +his application 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. ' . �, --------- -------- ------------------------- ----------- ------ --_--_--(Owner and/or Contractor) (Signed1 .._....".. r ---- -- - --------- - 11 �: (Tale)- _...._ ..."" By:----------------------------------- =----•-------------------- ---------------------- s ------n -- - - Plt,.plan,'showing size of lot, location of system in relation to wellis, buildings,,etc., can be placed. on,reverse side). = --( o - � 51 I FOR DEPARTMENT USE ONLY r APPLICATIONACCEPTED BY----- ---------- ------------- -------------------------------------------------------- DATE--------------.._.--------- --- ------------------------•---- - DATE REVIEWED BY------------- /...- Grj•..... - ----------------------------- DATE. -------------- BUILDING PERMIT ISSUED ----------- --- ations.a / r recomme ations:.} a -------------- Alter - ------- ---------- --•- --------- - a ---------- ----------------- -------- ---------- ----- -..-- ----- ------- -----• -------- -- -- FINAL' INSPECTION BY:..._____--- ------- Date--•---- ---------- w�� ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California/6 Tracy, California Stockton, California * ES-9-2M 145446 ATWOOD 12-54