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_ APPLICATION FOR SANITATION PERMIT Permit No. ..... (.,�. _ {Complete in Duplicate) Date Issued ---- -� /S__� Applic64-ion is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein described. I This application is made in compliance wi h County 0r di No. 549. JOB ADDRESS A D LOC TIO ---- ---- -- ,�. �rf!5.�-------- ----------- ---- --------•-•- Owner's Name----- =-1- -----j------- qq - -- -- - -- -------------------------- ---- - --------------------------- ------ -- Phone--------------------.....----...... Address---- .�,.�. - '.!•. T x mm. , �.. n, -- ---- ----- --------------------------�----------------------•---•- Contractor's Name._._- --------------------------- ------------------- -------•-••------------------------------------------------------- Phone----••--_------------------------ Installation will serve: Reside eApartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: __._Aumber of bedrooms .__'Jo f�umber of baths ----I— Lot size Water Supply: Publics stem f pp y: system ❑�Community system ❑- Private,� Depth to Water Table _�..�M Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �k New Construction: Yes ❑' No ' 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__-__-.._...____-Distance from foundation.-__.______._.__._.Material------__________________._.__--.--__;._________- o. of-compartments,,L, -- =tSize. -------------------------Liquid depth .------------- ----- Capacity------------------------ 31 Field: istance from nearest well _ .:Distance from found_----------/_Distance to nearest lot lin __/' I ❑ Number of I;nos___._ _, _._. _/ #'q'`: ___ _Length of each line--- __ y{.Width of trench_._ ��___--..`L_..________ ype o filter material_ �Depth of filter material---_____l.._�____._Total length_____ .�___�___ eepage Pit: Distance to nearest well...._�'.' ___-_-.__,_Distance from foundation-------__...........Distance to nearest lot line_______.___-____- I 1—• ❑ Number:of-pits "`;='-=-{-------Lining material-----------------------Size: Diameter-----------------------Deptn--------------------_----,------- � Cesspool: Distance from rnearest well______________'_Distance from foundation_____.._____.___.__.Lining material__._-___.._._ Size: Diameter----- x---- - , i-De th Liquid Capacity_ als. S ❑ p -----cl J - _ rte.. Privy:{ Distance from nearest well ---------- ----------------------------------:....Distance from nearest building---------------------------------------- El ______________ _------____❑ 'Distance to nearest-lot-I�ne___ -----------------------------------------------------------. ------------------------------------------- -----•--------------------- Remodeling and/or repairing (describe)------- � �- " .x- ------- --------------------------------------•----------•------------•------------•-------•--•-------------------------------------------------------•------------------•-- -- q ----------_-------------------------------------------_-----------------------------------------------------------------.__..------------------------------------------_-----------------------------_------------------------- r ' ---------------------------------------------- have prepared this application and that tate work will be done in accordance with San Joaquin County ordinances, to laws, and rule r ulations of San Joaquin Local Health District. } (Signed ) -----'-----i = -------------------------------------------------------- --------(Owner and/or Contractor Y� -----------------------------------------------------------(TifleY=-------------=-------------------------- ----- (Plot plan. showing size of lot, location of system in' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-------------- ------ ---- -- ----- -- -- -- --..._-. -----------------------•--- DATE-----------•---•---------- -------------------------------- - - REVIEWED BY-------------------------------------------- DATE------- - - BUILDING PERMIT ISSUED---------- --------------------- ---------- - � - --� DATE---------- ----------------- Alterations and/or recommendations:----— - -------------------------------•-----------------------------------------•------------------------•- ----------------------------------------------•--------------------------------------------------------------------------- ---------- -----•----••-------•--------------------------•--------------- ------------------------- ---------- ---------=--------------------2-------------------------------------------------------------1-•------------------- FINAL INSPECTION BY--------------- Date. ... �f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 14S446 ATWOOD 12-54 - r