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�� APPLICATION FOR SANITATION PERMIT Permit N Date issued ---- --'--1 1 omplete in Duplicated t to construct and install the work herein described made to the San Joaquin Local Health District for a permi Applica-�ion is hereby de in compliance with County Ordinance No. 549. This application is ma I------------------------------ ------------------------------------------ ------------r--------// ----------------------------------- JOB ADDRESS.AND LOCATION_ -----------.- Phone. f -------------- Owner - /\,/ ---------------- ------------------------------- ---------- sName_- --- --- ------------7----------------- ---------------------------------- Address-------_:_;2-----4 _7../------------ --------- ------------ Phone------------------------------------------- Other E] ------ ---- ctor's Name---- ----- Contra ornmercial [3 Trailer Court El Motel 0 installation will serve: Residence [B�, Apartment House 0 C s ---jLot size _ZZ------- ------------------------- edroorns _;;�— ing units: 1--_-- Number of b . Number of bath ft. ,Number o! living rn 0 Private 0 Depth to Water Ta Adobe 0, Hardpan [I Water Supply: Public system [5-71community system Jay Loam ❑0 Clay [] Ad Character of soil to a depth of 3 feet- Sand 0 Gravel 0 Sandy Loam 0 C I ew Construction: Yes K No 0 Previo6s Application Made: Yes C] No ®-- TYPE'OF —TYPE'OF INSTALLATION AND SPECIFICATIONS: permitted if public sewer is available within 200 feet.) Material-------------------------------------------"-""` ---------------------------------- (No septic tank or cesspool permi Distance from foundation------------------- Ji VT k- - Distance from'nearesf weli--------------- -- -------Ulqu,d depth_--.--.------------------.Capacity-------------- ------ Septic Tank: ��Go f comparimenfs----------_--------------Size-------•- ----------- - to nearest lot line------------ 0 �W� -.Distance from foundation--------------°-=---Distance ------------------------ Distance from nearest well_ ------- --------- ------Width of trench__-' Disposal Field: or - -------------Length of each line--- length---------------------------- ❑ Number I lines------------------------------------Depth of filter rnaterial__--------------- TyOe of filter material--_----_..- Distance to nearest lot line....",-------- I-VVDistance from founclation-- Distance to nearest well---A/1- ----Dep A,4ijk--Diameter------- Seepage Pit: Number of pits----j------- -------Lining mate rial- ............Lining material---------------------------------Tr- Ij- Distance from nearest well------------....Distance from foundation.. ._,.Licluid Capacity--.__------I---------------gals. Cesspool: ----- ----Deptb_----------------------------------------- --- 11 T Size. Diameter----- --------------- nearest building------------- ---------------- ----- 0 1 Distance from Privy:., Distance from nearest well------------------------------------------------- ------------ ------------------------------------ Distance to nearest lot line------------------------------------------------- ❑ --------------------------------------------------------------- escribe):------------------------------------------------------------------------------------ Remc�eling and/or repairing (describe}:------- ---------------------------------------------------------- ----------------- ------------------------------- --------------------------- -----I---------------------------------------------------------I -----------------_------- ------------------------------------------------------------------------------ --------------------------------------- ----------------------------------4- ---------------------------- ------------------------------------------------------------r------------- . t with San Joaquin Co y .......... ----------------------------------- and that the work will be done in accordance I hereby certify that I have prepared this applicationJoaquin Local Health District. State-laws, and rules and regulations of the San ordinances, Stat ContractorN ---------------------- (Owner and Signecl)--------- -- --------------------- - -- ---- -----------(Title)----- ----------------- --------- ------- -------------- . .... n reverse side). un etc., can be placed o L (plot plan., showing size of lot, location of system in relation to wells, buildings FOR DEPARTMENT USE ONLY --- 1. --------------------I------- ------------------- ------------ DATE----------------- --------------------------- APPLICATION ACCEPTED BY_----------.---.. -------------- DATE------------- - -------- cz ------------------------------------- ------ ----------------------------------------- -- ---- DATE REVIEWEDBY"._----------------------------------- - ------- _Z7---------- BUILDING PERMIT ISSUED------------- ----------------------------------------------------------.............. I ------------ --------------- ------- ------------------ Alterations and/or recommendations:-- .... --------------------------------------- ------------------- --- - •--------------------------- --------I--------------------------------------------- --------- -- ----- ------ ...... o,/ ---------- ------ --------- -------------- ----------------------------------------------- ------- --------------------- -------- --------------- -- --------- )-------- ------------------------ --------- --------------------- ----------------------------------------- ---------------------------------------------------- -- -------------- ----------------- -------------- --- ------------------ --n—l� ----- ------------------------------ ----------------- ------- .. ....... I-------------- ') 'S Date----------- - .-- FINAL INSPECTION BY----- ....... ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North 'C" Street 300 West 0A Street 132 sycamore Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California 545446 ATWOOD 12-54