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APPLICATION FO,1,,,.jANITATION PERMIT Permit No. ---7-33.. nom' (Complete in Duplicate) D Date Issued 4 Application is hereby made"to fhe 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 LOCATIONn -!----- �_ 4 ° 9C---`. ___ Owner's N e- -Ink *} !` L �- . ------------- -- Phoney---,�- 6 - Address_ '!.. .--4:2>1k...it �7.0 Contractors Name ---------------------•------------------------------ Installation will serve: Residence E?"'Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ d Number of living units: --I---- Number of bedrooms �+ Number of baths ._-)---.Lot size Water Supply: Public system ❑ Community system ❑ Private [' Depth to Water Table -------- ft. Character of soil to a e thlof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-"Hardpan ❑ Previous Application /Made: Yes E] No Er New Construction: Yes [ No ❑ TYPE OF INSTALLAfiION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--,-------------- --Distance from foundation--------------------Material---__._---.--_-_-----_.-----.------__-------_ r No. of compartments-------------------------Size--.----------------------------Liqu'd dep Capacity-------------f- A Number from nearest well-- --.-..-Distance from foundatiQ- I.-..-.. istance to nearest lot li 1`' I is osal�Fiel . 4 Distance of lines--------- . ..-._ - p --_Length of each line--------.__ -- Width of trench-_---. __ ll1-------------- Type os filter materi a.! iepth of filter maferial------- - ----------Total length---------- ---- -_---- � 4 Q t Seepage Pit: Dlsfanceljto nearest well--_------------------Distance from foundation-.------------------Distance to nearest lot line----------- ❑ Number ;of pits----------------------Lining material---------------: --.Size: Diameter--------------- Depth. ----- r Cesspool: Distance from nearest w il from foundati _ on...__.____..------..Lining material---.-._--.--__ --.-__.--_----------- ' ❑: Size: Diameter---- ------------- ----------------= Depth------ ----------------•-------------------------.-Liquid Capacity----------------------------gals. Privy: Distance'Jrom nearest well---------------------------_________---------------Distance from nearest building-------------.------------------__ ❑ Distance''to nearest lot Ake.-----�'----- `------------•-=-- ---- 3- :---------=- H Remodelin and/or repairing (describe): 4------- .......&- -•------ - -- "------- -r' ._-.- ; . -------------------- -•• -•-•-----••--••-------"---------•----•------- -----------•--•------------•------- --- --- •-------------------- ---------------------•------------_...-----------..----- �I - i -------------------------------------------------*--------------------------------------------------------------------•--••-------•--•---- ---------------•------------------ -------•---------------- 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 Joaquin Local Health District. � . --- ----------------------------------------- ------ ---��--- --- -- -- weer and/or r Contractor): By:---------- ---- - - - - - ---------------------------------(Title)- (Plot plan, showingszelot; �J ' location system in relation to wells,-buildings, etc., can be placed on reverse side). i t , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE BUIL -------- - ---- - ---------- REV ID NG PERMIT ISSUED ? --------- --------------------------------------------------- ------------ DATE EWED BY ------ ---- ---- ----------- ----- - -----------------------------------r-------------------- • ---•---------•----- DATE---- ------------------------I----------------------- Alterations and/or recommendations:---------------------__--------------------------------I q"~' - ••---------•-•----•---•------------...------------ ----------------------- ----------•-------------------------------•-•-----------•- ----------------------------•--•-- -------------------------------------------------u-------------- ---------------------- --------------------- ---------•------------- II - -----•-•---------------------------- ------- ---- ------------------ ------------ ----- -------------•-- -------.. --- ----------------------- ------------------------------------ FINAL --------------------------------FINAL 'INSPECTION BY:. --- -------------------------------------------------------• Date--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 11 300 West Oak Street +132 Sycamore Street 814 North "C" Street Stockton, California 1, Lodi, California Manteca, California Tracy, California ES--9.-2M 145446 ATWOOD i2-54 �I Q L