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APPLICATION FOR SANITATION PERMIT Pe'rmit No. (complete in Duplicate) Date issued T, n Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ion is hereby made to the San .th Count Ordinance No. 549. This application is made in compliance wi oWunT - , /V ---------------- _ ----&b �Z ---------------------------------------- JOB ADDRESS AND LOCATION---------- - ----- Phone------------------------------------ Owner's Name______ 7L __o__,b_,oqX----------------------------------------------------------------------------------------------------------------- Address--------------- .......... Phone----------------------------------- Contractor's Name-------- --- Installation will serve: Residence - - ❑ Trailer Court-. - El Motel 0 Other [I Eq--AApartment House 0 Commercialectrooms ---/-_ Number of baths ----L Lot size ---- J ------------------- `Number of living units: Number of b Private ❑R- Depth to Water Table 4—;37Tt- Water Supply: Public system DgL_ Community system 11 , Hardpan ❑ Character of soil to a depth of 3 feet: ..Sand 0 Gravel [I Sandy1oarn 0 Clay Loam[I Clay 0 Adobe gg' No No ;4-- New Construction: Yes E] Previous Application Made; Yes 0 a, TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tan.k or cesspool permitted if public sewer is nearest 0-7,0 %stance from foundat! Septic Tank: Distance from 1 .1_Di _A ---Liquid dep.th--------- ....... ------ 'P -- -Capacity No. of compartments_. —-—-------------Si,e_ line--- x - afion_____/1 {-----DiIf Disposal Field: Distance from nearest well-./V 7z4 /- tance to nea'rest lot 0 .-Oistance from found ---� dtlh of trench---- -- ---------------- f 0-;11------------ Number of line s--------i------- ------ ----Length of each line .. ....Total length--------- -f C - e�Depth of filter material_._...-1-- --a 16/ 1 Type of filter material oto nearest lot line---._------------ Distance to nearest well_ Ab-;��- istance from foundation--- -----9�----Distance dr Diameter__-_ 57 Depth Seepage Pit: Number-of pits..----/-------- -----Lining material_ __/ - WL _Distance from foundation...-_.-_-.----_---------- Lining material----------------------------------- Cessp nearest well-------------- ..L;quid Capacity----------------------------gal Cesspool:. Distance from. Size: Diameter.---- ------ -------- ------ -------Depth------ ------_--------------- - -------- -- El 1,rom nearest Wei�------ -------------------- ----------------- ---Distance from nearest building----------------------------------------- Privy: Distance ------------------------------------------------------------r--------------------------------------------------- Distance to nearest lot line.----------------------- ❑ Remodeling and/or repairing (describe)----------------------- -------------- -------------------------------- --------------I--------------------------------------------------------------------------------------------------- ------------------- ---------------- ------------I-------------------------------------------------- ------------------------------------------------------------------------------------------------------- ---------------- -----------r------------------------ ------------------------------------------- --I------------- ---------------------------------------------------------------------------------------------------------------- -- - -----------------------------------------__------------------------------- ------------------------ will be done in accordance with San Joaquin County I hereby certify that I have prepared this application and that the work Ith District. �.Sla ws, and rules and regulations of the San Joaquin Local He'a ordinances, Sta ---------------------------------------:--------(Owner and/or Contractorl ----------- ------ -------- ---- ------- ------ ---7 00, - --------------------------(Titley- --------------------- ------------ ------------- placed on reverse side)., y in relation to wells, buildings, etc., can be (Plot plan, showing size of lot, location of system FOR DEPARTMENT USE ONLY DATE,- ��, --------------•------- REVIEWED ACCEPTED BY-------------- ------------ ----I ------------------I-------------- ---------------------- ---------------------- -------------------------- ------------- ---_------------- REVIEWED BY--------------------------- ------------ ---- - - ---- ----- -------- ------------------- DATE------ ----- --------- ---------- BUILDING PERMIT ISSUED--------------------------------- ----- ----------- '-------------- ---------------- -------- ------ ----------- Alterations and/or recommendations:---------------------- ----- ------- ----------------I-------- < -------------- ------------------------------- --- -------------------------------- --- ---------------------------------------------- ---------------------------------------------------------- -------------------------- ----- --------------I ---------------------- -- ------------------------------------------ --------------------------11-------- ----------------------- ----- ------------------------ ------------------- --------- ------------ --------------- ------------------ ------- ------- -----------------------------------------I------------ ----------------------------------------- -------------- ---------------- ............ ----------- ------- ---------------------- ----------------------- -------- ---------------- -------------------- Elate; J-9--- 5,�4-------------------------------- -------- FINAL INSPECTION BY:------------------ ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 614 North "C" Street 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California rE__9_2M 145446 ATWOOD 12-54