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APPLICATION FOR SANITATION PERMIT U{ Permit No. - _ ---� '' (Complete in Duplicate) ' . 53 3 q' LA), Date Issued ---------------i c e�crn�a - � /� ------- '= Appficafion is hereby made to the San Joaquin Local Health Di str - ict for a permit to construct This application is made in compliance with County Ordinance No. 549. and install the work herein described. JOB ADDRESS ANOCATION ' � : ---- - Owner's Name._______ Address D_ .- _.. �� -- -- ------ -------------... Phone------------------------------------------------- • ---------- -. Contractor's Name---____-- -Afil-A-T— � � -- __ -"----------------•--------- Phone---•-•-------------- -----------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other i Number of living units: I____ Number of bedrooms S._ Number of baths ____ ___ Lot size ___-�119 / ❑ Water Supply: Public system E3 Community system ❑ Private �'�epth to Water Table �ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardgan,❑ Previous Application Made: Yes ❑ No F��lew Construction: Yes ®-'I1T0 p TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest well/i(r�-------- Distance Jrom foundation_ No. of compartments__ --___..____Size_ Liquid Capacity . - - -- -- - - �- --•-----Liquid depth- - —, ,ff p Y • 'p 1?----- Disposal Field: Distance from nearest well- ----__ Distance from foundation__��•Distance to nearest I t line_ ------------- -------- `- 1 Number of lines______._ Length of each line___ -__- _-- ne - Type of filter material-__.��•'.._ i __-Depth of filter material___- _ --- ----- Width of trench-- .4. Z 6 Total length -------------• -------- Distance Pit: Distance to nearest ell-__� - _- ell---- --- - _._.__-Distance from ound�`�ion --------- nce #o nearest lot iine_.l ~-_- Number of pits------ -----------Lining material_(��_G'_ Diameter-J9.��---_.Depth------ - %- -------- ---- Cesspool: Distance from nearest wel!_________________ (� Distance from foundation--------------------Lining material_____-__._____-.._._ El Size: Diameter------------ -------------- ----------Depth------ -------------------------------- - ------Liquid Capacity---------------------------gals. Privy: Distance from nearest well__.__-_._.____________________________________ Distance from nearest building El g Distance to nearest lot line .__ ' --- ---------•----------------- - ------------ --- Remodeling and/or repairing fdescribe):----------- � it _ -- - __ - --I --- -- - --- ----------------------------- -------------------- ---------------- -------------- ! hereby certify that I have prepared this application and that the work'will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Jo quin Local Health District. A d y I (Signed)-------••- 2 �i� - ----- r£ r� c c ( --- j' l O OP) -------------------------------------- {Title) . -tet Plot len, showing --------------- ------------- p g 1 e of lot location of system in relation to wells, buildings, etc., can be plac d on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------... ....... -------- - ------------------------------------ ------- DATE--------�--------------------- REVIEWED BY----- ------------------------- --------- ------ -- ....................... ----- ----------- ----------- ------------------------ DATE -------- ------�•- BUILDING PERMIT ISSUED----- --------------------------- -� ------------------------- -_ ---- -- - DATE------ ---------- �- Alterations and/or recommendations:__..___.- �- ------------_------- -- ------ -------•------------------ --------------------------------------- --- ---------- {� - j i '--1-------------'e -•-----•-----•-------•--------- ---------- ----------••---------•-- --- - ----:-� -----------------11----------------------------------------------------------- ---�-------� °''-�-'- �-��..�. .`-_��'_�- ;_Irk,-.- - • - t__ . . - ---- FINAL INSPECTION --------------------------------- ------ Date.- SAN JOAQUIN LOCAL, HEALTH DISTRICT 134 South American street 304 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California �5�—�M 145446 ATWOOD 12-Sa