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f Permit No. ._�-_ '_ .. APPLICATION FOR SANITATION PERMIT ! [Complete in Duplicate] Date Issued Applica+ion 1s hereby made to the San Joaquin Local Health-District fora-permit to construct and install the work herein described. 03 0 r This application is made in compliance with County Ordinance No. 549. 1 -'` --------------- k JOB ADDRESS AND LOCATION_..___ Phone------------------------------------ Owner's -=------. Owner s Name_______-_--- _ Address------• ----- --- ---------- ----------------------------- --------------------------------------------------------------- --------------- - --------------------------- Phone-- ----p'�et.-- --�•-- - -�7 Contractor's Name-----D.��,- "-'----•��' •- -- --"'" ----4-------�'0- �-------_-- - Installation will serve: Residence 51 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__._ Number of bedrooms ` Number of baths j---- Lot size -------6_D------ -----------•----------- Water Supply: Public system Vff Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1 ' Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.]` Distance from foundation__..rt_d-------- --.Material-___�_- -----------��--'-�`."�'C---------•� Septic Tank: Distance from nearest welL_/il - 3 Li uid de th_.._____ .d-��- ----Capacity__-__-4 ryl No. of compartments �- - Size x q �R r W' 3 --..____....Distance to nearest lot line_--____ Disposal Field: Distance from nearest well_- / Distance from foundation______ rUl Number or lines___.____---___ ---------Length of each line--------J-6......----.-.Width of trench.______��__---------------- � } y � kL�epth of filter material-----�-g .-- -----.Total length--------/ ------------ Type of filter material__ ---- -- - -- Seepage Pi}: Distance to nearest well_____________"__._____Qistance from foundation________--___.__--_.Distance to nearest lot line----"__.--------- t Number of pits----------------------Lining material----- ----------------.Size: Diameter----•----------- ------De pt�n Nf! Cesspool: Distance from nearest well-----------------Distance from foundation.--.______-.._._-_.Lining materia4_______________________._____-._ ti als.�. � ❑ Size: Diameter--------------------------------------Depth------------------------------------- ---------------------Liquid Ca acity- ---------------------- Distance from nearest well-----------------_--------_----------------------Distance from nearest building._______-..._._-__________-___"._____.._ Privy: ❑ Distance to nearest lot line----..__----------------------------- -- - ---------------------------- ------------ -------------- -------------------------------------- Remodeling and/or repairing (describe):--- ------------- ------------------------------------- - ---------------••----------------- -------- ------ ---- ------ 1 hereby certif shoo dhra lespandaregulations olf the San JoaquinhLocal HealltheDistrictn accordance with San Joaquin County ordinances, Stat a 5i ned ------------------------------------------- ------------------(Owner and/or Contractor] -- --- - ( 9 (Title)---- pS—- _. By' buildings, etc., can be placed on reverse side]. (Plot plan, showing size of lot, location of sys+em in relation to wells, FOR DEPARTMENT USE ONLY DATE------ ------------------------------------- APPLICATION ACCEPTED BY------ -------- ------ --- --- ------------------------------------------ ----- ------------------- -- ---------- ---- DATE--- - -------- -------- ---------------------••------ REVIEWED BY --- --- --- --------- ----------------------------- BUILDING PERMIT ISSUED------------------------ ------ -- ------- ------ Alterations and/or recommendations--------------- ------- -------- --------------------------------------------------------•------------------------ 11 ------------------ --• -------- ----•--•------------ ------ ---------------------------- ------ ------ • -�-•-- ------------- Date--- - --- -- -=- - FINAL INSPECTION BY:---- --- s SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street frac California Stockton, California Lodi;-California Manteca, California Y• E5-9�2M 145445 ATWOOD 12-5. _ ...