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APPLICATION FOR SANITATION PERMIT Permit No. __--.r- (Complete in Duplicate) (/! ��•�j Date Issued "`2!""��S(• Appliceion 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 'th County Ordin ce No. 549, r JOB ADDRESS AND LOCATION_..__ _ _ - - �, � r �----- Owner's Name iza—d.r-r- Address- -- a�, / -- ------- Y_ ----------=---- Phone -----•---------------------------------------------------•- -•-------•-------------•--------------- Contractor's ---- ----•-------------- - - ----- --- _____________ __ ____ - - ------ ---------- --------------- Phone_.----•-•------------- ------ ---•- Installation will serve: Residence Apartment House [] Commercial _- Number of bedrooms ._ [I Trailer Court [] Motel [] Other ❑ Number of living units: ." Number of baths . Water Supply: Publics stem " Y ❑ Community system ❑ Pnvat of size •� ----------------- Character "-""-_""""-"""_Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sat, Depth to Water Table __ C? ff. Previous Application Made: Yes ❑ Clay Loam 0 Clay ❑ Adobe PI Hardpan ❑ ❑ No ]] New Construction: Yes n. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank: Distance from nearest well_ ' -Distance from foundation____ No.'of com artments- y Q --Mat r' ps-------------Size. ?_X__ Xk -Liquid depth_-. - ---- Capacity_. . Disposal Field: Distance from neares well.:f.�f3- Distance from foundation___-10---_-Distance to nearest lot lrne_-" Number of lines____----t--- f` --------""___;Length of each Gne__, , �--_.--- " Width of trench-"- 2---- TYPe or {filter ma#erial_�.?'-."�=��pepth of�filfier.material_�.g.��_--.--------Total length__---_1"-��- -------------""_-- Seepage Pit: Distance to nearest well-.- ___---._Distance from foundation____________________Distance to nearest lot fine_--".-_"-_"_-__ ❑ Number of pits--------.-------------Lining material" _ _""-"-- Diameter________________ -- --- Depth---------Distance from nearest well ---------------------- El ---- ---- -------- -_...- _ .._.. ❑.�._., Size. DiameterDepth�--- ., : -"-__" ancerom foundation ." Lining material------ 4--_--- ---Liquid Capacity Privy: Distance from nearest well.-- " --- "-- _ ------------gals. _ El Distance from nearest building Distance to nearest lot ----__ m line_--__"--- - ------------------------ - Re ing yin K a in j (descri�e): G sf r�S�LO. G �% . dc-dO--_ ------------- ----------- I hereby certify that I have prepayt:1-S-`application andghat the woo will be done n accordance with San Joa um --------------------------------------------------------- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 9 County (Signed)____x" - Owner and/or Contractor) By:---------------------------•-------•-------------- --- - -- --------------------------------------------- ) ------ ------- ------------------- --- - -- -- --- - - - - - - - -(Title)----------------- ---------- of plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U_SE ONLY APPLICATION ACCEPTED BY REVIEWED BY - ------------- ---- BUILDING PERMIT ISSUED._----------•----- - T `� (e/1 0 ---------------------- --•-------------------- - ----- ------ ------ ---- Alterations and/or recommendations:______.-._." / ------------------------ DATE------I----------- - ___-___.____-_-_____________-_- _ _____________________ _. _____________ _______-_____._--.______--_ _______________________ ..__._.-___._ ____________________________________________ ____________ _ _ ._-_-___-_-_--_______-__-______---______-_-.___--_--__---__-____--__._____ ________________________ ______ t ------ FfNAL INSPECTION $Y:--_._--.--"". ------- 12-A /S4Z Date --- - ---•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California es-9—ZM iasaac ATWOOD 12-54 -