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Permit N ..Lt....�� APPLICATION FOR ,..ANITATION PERMIT �`� �_ f / (Complete in Duplicate) � Date Issued ------- --5---� Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This'app lication is made in compliance with County rdinance No. 549. JOB ADDRESS ANDLOCATION---=------�----- --�-- ---- ---- - .y- -------------- Owner's Name --------------I----- -------------- s Name________________ ___ --------------------------------- Address ----------------------------------------------------------�------------------------------------------------------------------ -••_.� Contractors NaG ,�_'u,�2�... "`. z Phone_ .,� me- Installation will serve: Residence [�/Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel s❑ Othe. [_1_7 : . �. Number of living units: -1----- Number of bedrooms .'2-- Number of baths ___1____ Lot size ___-_ . _ Water Supply; Public system �ommunity system ❑ Private ❑ Depth to Water Table -0 ft. ❑ y y Adobe Hard an Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ P ❑ Previous Application Made: Yes ❑ No �w Construction: Yes &?-"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - .�. ,. Septic T k: Distance from nearest well__,___ ----- Distance from foundation___________________Material________----__._-._____.-___________.._______.. �� No. of compartments---------- Size-------------------------------- ----- -` Size--------------------------------Liquid depth-------------- ------- ---Capacity------- --------------- �. Disposal Field _ _ : Distance from nearest well* .-.__- ...-Distance from found ation--------------------Distance to nearest lot line__..____..______. Number of lines-------=------------------- - ----Length of each line--- --------.-- ---.Width of trench------.---------------------------- Type of filter material------------- --------Depth of filter material----------------------- length---.-----------------------�-•------ Tl f_.Distan� e to nearest l�lir� _-_._.._--__-Seepag it: Distance to nearest well_ __f11.�-------Distan from foundation____ _nt Size: Diar_ Depth Number of pits._�------------------Lining materials__ - �"-- o Cesspool: Distance from nearest well_______________-Distance from foundation-_-_._______..___{_.Lini.ng material__.___-____.__.__.- gals. ❑ Size: Diameter---------------- ------- -------Depth--------------------•-------------- - -------------Liquid Capacity--------------------- ._ Distance from nearest building------------------------------------------ Privy: Distance from nearest wel4--------------------------------------------------- .�„ Distance to nearest lot line-----------------------------------""-------- -------- El f .. -- . r .,' --- - ------ - -- ----- ---------------- v Remodeling and/or repairing (describe]:____.---- ------- ---------------------------------------- •---•--------------•---•-------------------------------------------------- • ---•----------------- ------------------------ i -------------------- - � --------------- ed fhisL ication and-that ordinancesty , Ila have regulations olf the San Joaquin LocalkHeall Health District. accordance with San oagwn oun ' - ---- - --------(Owner and/or Contractor) . (Signed) ------------------------- --------- - -� le) (Tt+ k Sy:---------- ---- ;0fl -----Z-0- "'---------- , [Plot plan, showing size , location of system in relation to wells, buildings, etc., can be placed on reverse si ! 4 FOR DEPARTMENT U-SE ONLY '--- �_ - DATE P APPLICATION ACCEPTED B ----=------------ -- --- - ------- Y �d .�" DATE---------- ----------------•- -- d -------- REVIEWED BY----------------------------------- - , BUILDING PERMIT ISSUED------_----------------------` -------- - ------ ---•--------------------' DATE._------------•------------------------ -------------• -- / ° ...... " Alterations and/or recommendations:___ , ----_-- ------------------------------------ - ---•----------- ------------------------------ --------------------------- --------- F_.._-..__--_.._____ ;r Date.... ._ . ,------------------------- FINAL INSPECTION BY:.---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South Amerie'an Street 300 West Oak Street Y Tracy, California Stockton, California s Lodi, California Manteca, California y. f., ES-9 1 145446 ATWOOD -