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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- Y_ �7�_ Applica-%n is hereby made to the San Joaquin Local Health District for a permit to construct install the work herein described. This application is made in compliance with County Orpri�ance No. 549. !,7 " JOB ADDRESS AND L ATION--------------- ---f------ ----- ----------- --- ...... --------------------------------------------- ------------ -I----- ------------------- Owner's Name.-------- - --------�9--------- ----------- . ................. ........----------- Phone.- ----•--C--Z> ------- Address................ .... ............ -------- ......... ------- ------ Contractor's Name---- ........... ------------ -- -------------- ---- --- -- ------------------------------------------------------------------ Phone,4�_4rX-917----- Installation will serve: Residence V!Apartment House ❑ Commercial E] Trailer Court [-] Motel El Other E] Number of living units; I---- Number of bedrooms ._ of baths I---- Lot size ----7�;47.__��Z_17�_— ------------------ Wafer Supply: Public system E] Community system E] Private Number Depth to Water Table __-Xvff. Character of soil to a depth of 3 feet! sand 1771, Gravel E] Sandy Loam Ej Clay Loam E] Clay E] Adobe A`andpan Ej Previous Application Made: Yes E] No EDol�ew Construction: Yes 0 No F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perlmiffed if public sewer is available within 200 fee+.) Se *c Ta k: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------- __._________.___._.-_..-_. No. of compartments--------------------------Size------------------- ------Liquid depth-------------- ------- Capacity---------- --- -------- Dj4togl Fie�l Distance from nearest well.................Distance from foundation--------------------Distance to nearest-lot line_______-.--_____. Number of lines------------------------------- ---Length of each line------------------------------Width of french---.------------------I ------ Type of filter material-------------------------Depth of filter material___._-_._.. Total length_________________________________________ W Seepage Distance to nearest welLI Distanc r foundation____ -------Distance to nearest-lot line----- ------- 0 Number of pits----.'-----.---------Lining materialArA---------Size. Diameter------�33 Deptn. - ------------------- Cesspool: Distance from nearest well-------- -----_Distance from foundAfion------------------- Lining material------------------------------------- Size: Diameter. _1 1 El ------------- --- ---- - - ----- Depth--_ --- ------------------- ---------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------ ---------------------------- ------ ._._Distance from nearest building------ --------------------------------- 0 Distance to nearest lot line__._:_------_-__-___-___-_.1 ------------ -------------------------------------------------------------------------- ------------- Remodeling and/or repairidg (describe):------------------------------------------------ ....... -------------------- ------------------------------- ---------------------------------------------- --------- -------------- ------------------ --------------------------------------------------------------------------------------------- ---------J ---------- ----------------------------------------------------------------------------------------------------------- ........----------------------------------------------------------------------------------------- --------------------------------------w--------------------------------------------------------------------------------------------------------------------------------------------------I ------------------------- I hereby certifyhaffAhave prepared this lication nd that the W rk will be done in accordance with San�Joaquin County ordinances, State la a r u I e!��,.a regul ' ns of�Dp I the S Joaquin Lo al Health District. --- -------- ------------------------- --------------- - --- - ---- - ------------- (Signed].... - -------- ------------4+ - ...... ------------ Contractor) - By:---- ---------------------------------------------------------------------- ----------- ------- ------ --------(Title) �-VC_ --_%zz 7 X ------ - ----------------- (Plot plan, showing size of lot, location of system in relation to 61 , buildings, e ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------ DATE REVIEWEDDATE-----------------------_ -------------- BY-------------------------- ---------------- --------- --------------- ------------------------------------------------- DATE-----------------------_ BUILDING PERMIT ISSUED_____-:_-------------------------- ------------------ ----------------------------- --------- DATE------ ------------------ Alterations and/or recommen4aiions:--- ...................... ....... .. -------------------- ----------------------------------------------------------- ------------------------- ----------------------------------------- -------------------- ------------- - ------ -------------- ---------------------------------------------------------------------1-1-----------------------............ ----------------------------------------------------------------------------------------------- ------------------------------------------------------------ ----------------------------------------------------------------- ------------------------------------------------ ------ ------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------I--------------------------------------- -----------I--------------------- 7----------------------- --------------------------------------- --------------------------------------------------- FINAL INSPECTION BY:---------------------ff__Avat�----------- Date----------- -#� -----------------......... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12.54