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�t`Y APPLICATION FOR SANITATION PERMIT Permit No. .... 3 3-_ (Complete in Duplicate) Date Issued ---�.___2� . Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....-- _ _ - �--- ---- . ~`---------- •---------------- Owner's Name-------- 4---A / ---- ---------------- Phone 7f/ F (/ �_ Address----------------------- --- --------- -- ------•-------------------------- ---- - --------------------------------- -----•--•-------------------------------------- Contractor's Name. - . 1 _ '• Phone.- 1.07----- Installation will serve: Residences �partment House El Commercial ❑ Trailer Court ❑ Motel [:] Other E]L Number of living units: _J'/_- Number of bedrooms _3-.- Number of baths _11"Lot size _� 11_.� _.f.`�- _ --_. ._. -___ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe "rdpan E❑ Previous Application Made: Yes ❑ No D- New Construction: Yes ❑ No ❑ G� �%�--�-�; `' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Tank: Distance from nearest well --. .- Distance from foundation- - --.__- -M,aorial_________.__-_ - , �*. No. of compartments.... ---------------Size_�".1 �11--:�_ -Liquid depth---______. ._------------Capacity--- ------------ r �[7 sal F' Distance from nearest well.................Distance rom foundation--------------------Distance to nearest lot line----------------- � Number of lines_--.-------------------------------Length of each line-------.----------------------Width of trench----•-------------------------____- Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------.------.d pace P't:r Distance to nearest well----------------------Distance from foundation_.------------------Distance to nearest lot line---_---__--_----_ Number of pits----------------------Lining material-----------------------Size: Diameter-------------..--------Depth--------------------------------- Cesspool: Distance from nearest well-___--___-----_Distance from foundation....................Lining material-------_._-_ _----.-.--_------- ❑ Size: Diameter---------------------------- -- ----- Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy., Distance from nearest well-------------------------------------------------Distance from nearest building----------------------._....-------------- ❑ Distance to nearest lot line-- --- ------------------------------------ ------------------------------------------------------------------- ---------------------------- Remodelingand/or repairing (describe):-- -------------------------------------=-------------------------------------------------------_-..................................................... -----------------------•--•---=------------••--------------•-•-------------------------- --------------•---------------------•----------------------•-=-------•--------------------------•----------------- '.✓'f -------•---------------------- --------•------------••-----•-------- ------ ------ ------------------.....-----------------•.------------------------•------------------------------------- a --------------- ------------------------------------------------------------------------------------•-------------------------------------•--•-------------------------------------------------------- ------ 1 , I hereby certif hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State i , and rules regulati s of the San Joaquin Local Health District. 4 amu; -Pweiis, ----------------------------------•------------------ ------ Contractorl (Signed)---------------------------- By----------------------------------------------------------------------- ------ -- - --- ---------------•-(Ti+lel —- - ------------------------------ (Plot plan, showing size of lot, location of system in relatio buildin etc., can be placed on reverse side). FOR DEPARTMENT IJSE ONLY APPLICATIONACCEPTED BY------------- - - ---- ------------------ ------------------------------------------- DAT ------- ---- ---------------------------------------- REVIEWEDBY---------------------------------- --- = -------------------------- ------------------------------------------ DATE------ ----- - - - BUILDING PERMIT ISSUED------------ -------------- - --- - -------------- ---- DATE ---------- --------------------- Alterations ------- --------- Alterations and/or recommendations--------------- ------ - -- -------------------------------------------------------------- ---------•--K�3z- -----.•.-� ---------------- ----------- ----------------------------------•-----------------------------------. ------------------------------------------------------------------ --------------------------------••---------------. -----•------------------------ ------------ . •• ......---• -------------- ------- -------------------------•--------------•------------- • •--------------------------._...- ----------------------------.-----.----- ----------------- ....... . . ......... ----------------------------•------------ -•---------------------------- --------------------------- •-------------- gi� Date-- '—� FINAL INSPECTION 'BY:...... ------------------------------------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California rs-9-2M 145446 ATWOOD 12-54