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• Permit No- - - ---------- APPLICATION FOR SANITATION PERMIT �h ) (Complete in Duplicate) Date Issued .----- -- {� Joaquin Local Health District for a permit to construct and install the work herein described. Applica4ion is hereby made +o the San g a ce-with County Ordinance No. 549. - -------------------------- This application is made in coin Ian p N--a - Phone. ----------------•----------- JOB ADDRESS AND LOC T :----------------- ------••---- -------••---••-------••-------------------•-- Owner's Name_ - a ---------- ---- ----------- Phone` ,Address----•-------- --------••----------- ----- ^^= Motel ❑ Other ❑ Contractor's Name__. - -- Tai er Court ❑ Commercial � �- ApartA ment House ❑ �r ---"---------------- Installation will serve: Residence ❑ p Number of baths j---- Lot size -_4-,Q--- Number of living units: __-.__:-`Number of bedrooms -- Depth to Water Table�Q ft• mmunity system ❑ Private ❑ p Adobe ' er'dpan ❑ ' Water Supply: Public system ❑ Clay Gravel ❑ Sandy Loam ❑ Clay Loam Y ❑ Character of soil to a depth of 3 feet: Sand ❑&.—New Construction: Yes ❑ No Previous Application Made: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ( P permitted if public sewer is available within 200 feet.] No septic tank or Cesspool - --------------- ' tic Tan Distance from nearest well--------- ----=--D1zseance from foundatiLau�d-"depth__Matena=_---.__.Capacity • No, of compartments .. .. --- Sep isposal Fief ' Distance from nearest well--------------- Distance from foundation-------------------- to nearest lot ine.____------------ Length of each line Width of trent ----------------------------------- *VNumber of lines ---- Total len th Type of filter material-------------- Depth of filter material- '0- g - _Distance to nearest lot line_- --------- R Distance om fou dation-_--- � �� D ------------------- Number --- ---------- { Seepage Pi+: Distance to n Barest wells' '-�'-.- ize: Diameter- ------------- eptn__ Number of pits------/--------- ---Lining material._ `�+__ Liquid Capacity----------------------------gals. ' Distance from nearest well_______________ Distance from foundation--:-.---_---.--=--Lining materia--------------------- Cesspool: Depth-;---------- Size: Diameter----- ---- --------- ❑ Distance from nearest building - ." _ _______________________.___._ --.------__ Distance from nearest well.--------- # - - Privy: > ❑ —Distance to nearest lot" tine----_-_-."------- ----- - --- -- Remodeling and/or repairing (describe):....... . ......... ----------------- --------- - ----------•----------------------- ------------ --- --------------------------- ----------------------- - -------------------- - ------------------------------ ty I hereby certify that I have prepared_ re orad this application the San Joaquin Local Heallthedone Distr ctn accordance with San Joaquinoun ordinances, State laws, and rules and regulations Contrac+or( -------------------------- ------ (Signed).._ - itl ----- --- - lT' el gY= plot Ian, showing size of lot,'location of system in relation to wells, buildings, etc., can be placed an reverse side). l r f FOR DEPARTMENT USE ONLY ------------------------------------------------- DATE----- --------------------------- --- APPLICATION ------•--------- APPLICATION ACCEPTED BY-------------------- --------- -" DA --- - 1 - ------- 5 REVIEWED BY------. DATE-------------- -------- - - BUILDING PERMIT ISSUED--'` --•--------- -------------------------- or recommendations:----------------- 1 j Alterations and/ ----------------------- ----------•------------------•------- J" ------------ ----- •-------- - -- ----------- Date----- -- ---------------- ----- FINAL INSPECTION :- - I SAN JOAQ UIN LOCAL HEALTH DISTRICT 132 Sycamore Street 914 North "C" Street + 300 West Oak Street Tracy, California 130 South American Street I Lodi, California Manteca, California Stockton, California E5��9�2M 145446 ATWOOD 12-54