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� �✓ // pp APPLICATION FOR SANITATION PERMIT Permit No. ..(0-If (Complete in Duplicate) Date Issued - � I 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. 543. JOB ADDRESS AN LOCA I N---•10-13------au7j; ` --C- l Owner's Name---n--.. - --•• - ---------- ....•-•------•-'---------- ------ ------ Phone-------------------------------------- 41� t.. `17_9-el �`"---"� ----------------------- - p Contractor's NaltJl.lit. ---- ' (---- - ---- ------------------------- Phone ._._ ?-1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..../_ Number of bedrooms ___Z Number of baths _/-_- Lot size _------------------ 1 i Water Supply: Public system 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 6R-11ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well _- rXA)__Distance from foundation-W_-.---_--Material_... __ . --_-_---_--__ ---___ No, of com artments__ .Sizif e��- --------Liquid depth__ ��._.____..Capacity.�Q � p Disposal Distance from nearest weal..-Distant e r3m foundation__ 4O`.....Distance to nearest lot line_----�,1' . LR' Number of lines----/----------------------------Length of each line_ _----.-----..Width of trench. n1°__------_----.. Type of filter material--1_AA,--- R � Depth of filter material-____ -. ._.__.Total length___ G Seepage Pit: Distance to nearest well-________ _ ______Distance from foundation---------_-----------Distance to nearest lot line-----__-__---_-_- l! ❑ dumber of pits--------------------Li ung;_material----------------------Size: Diameter---•--------- .......Depth--------------------------------- Cesspool: Distance from nearest well_ '-------------Distance from foundation---.---------------.Lining material_--_---__------_--._.--------------� ❑ Size: Diameter--- ----------------------- - Depth------------------------------------------ - Liquid,Capacity --------------------gaIs. = _- n,.�_..�. .w,..r.....Y,.. . �r _-�..�..�-.�D+- __..,..-..,�.._.tom_--.r ----------------------------------------- PrivyF-1 : Distance from nearest well ____ __________ __`____.-. __..._.___._ is ance-from nearest building.__--- _--_ _ --_. .--_ --_.-.--.-.-. Distanceto nearest lot line------------------ n--------------------------- -•-•------------•-••---------------- ------------------------------------------------------- h Remodelingand/or repairing (clescrib'e):-------------------------------------------------------------------e-----------------------------•--............._.-----------.-------------------•----- ------------•---------•--------------------------------------- ----•------------------- --------------------- -----------------------------------•-- •-•---------------------•-•--------------------------------------------- - ---------- ------------------------------•-------- ----•--------------------------------------- - I h eRe-rthat I have prepared t ' pplicatton a that +he ork will be done in accordance with San Joaquin County ordinances, an<rul and regu t' ns of the S Joaquin L cal Health District. (Signed)------ � ' q-------- --- ------------ -------------------- Contractor) By:----••••------------------------------------------------------------ --------------- ----- -- ----- ---- -----(Title)- - - - ------------------ (Plot pian, showing size of lot, location of system in ref o to'we11 .' building etc., can be placed on reverse side). FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 02 aJ ------------------- DATE- ,` / �'-------- REVIEWED BY------ •---------------------------- = --- DAT/ ! ;} - BUILDINGPERMIT 1SSUED.--------------•`----------- ----------•-------:------------------------------------------------------ DATE---------------------------------------------------------,--- Alterationsand/or recommendations------------- ----------- --------------- -------•-••--------------------------------•---•-••----------•---•----•-------------•--.-....------------------ ------•-------------------------•------------------------ ---------------------------------- ----------------------------------.--------------------------......-------------------------------------------------------------- ----------------------------------------------------- ----------------------•--------------------------------•----- ------------------------------------ ------------------------------------ --------------------------- -------------------------------------•--------------- t. ----------•-- • ------------------------------------------------------- ---------------------- FINAL INSPECTION BY--------------- -- --------------------------------------- Date------ ---------- ,. --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54