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�. Permit No. .-�-••----••••- APPLICATION FOR SANITATION PERMIT / 1Complete in Duplicated Date issued - J S . l 9,7— a 5 o.-c.G licaa-ion is hereby made to the San Joaquin Local Health e No. 5for 49 a permit to construct and.inst�all� e herein described. u hpPaP 1, t, is made in compliance with County Ord _ - - -- ------ pp�� n.! srr J� G /�� = Tri `, ---------------- F JOB ADDRESS AND LOCATION----- --1 — ------ Phone----------------------------------•- ------- = Owner's Name......... --L�r- -------------- Address--•--. Phone ------------------ Other ❑ Contractor's Nama._.__..__ __ " 'Trailer Court ❑ Motel ❑ installation will serve: Reside e Apartment House ❑ Commercial ❑ d w Number of living units: y/--- Number of bedrooms - .'.- Number of baths'.--Z-Lo size ----- I Public system ®_.Community system ❑ Private ❑ Depth to Water Water Supply: ❑ y ❑ Adobe� Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Previous Application Made: Yes ❑ No lg_ New Construction: Yes& No 171 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. f �� Ca acit ------- Septic Tank: Distance from nearest well-"N arDistance from foundatiLiquid n------4)...... Material � y--_� Size_- e q p. No. of compartments_.....: �. [�. Distance to nearest lot line"_ ---••-- �starnce from foundation___----- . - e Disposal Field: Distance from nearest welL./l�t`s2CR / Width of trench-�---- Number of lines-- ,1-------=----------Length of each line---•---.�a�J- �� - --------------------- j . ial" ..I -� .Total length --------- Type of filter material-_.`;i.---�- - De th of filter mater -_ ---------------!- -- _ �0--_.-".Distance $o nearest�llo7t line___ Q.----- Seepage Pit; Distance to nearest well__ 4jke -Distance from foundation.__.______ Depth- f� Diameter_- P _ Linin material__...-.""-- -- -- ` .. Number of pits---�---------- -- g Distance from nearest well-"_----- ------Depth C-- from foundation--- ----- ------Liquid Capacity_-.._----------------------gals. Cesspool: ❑ Size: Diameter------ --, ""-- --_---Distance from nearest building----------------------------------------- Privy: -"-- -----------"------------ -- --- Privy: Distance from nearest well._-- .-"--- --- ------- ------------ Distance to nearest lot line__..____________---_--- ------------•-- --� Remodeling and/or repairing (describe)---------------------------------------------------- --•--- - - ----•----------------------•---------------------- -•--------•-- •------ -•--•-----••-------------------•------•---•----•----------- I hereby certify that I have preparedthis application olf the San Joac{u n Local Health District. accordance with San Joaquin County ordinances, State,] , and rules andregulations ` ------------------------------- __ (Owner and/or Contractor] 5i ned ------ ( 9 (Titl ` -- e� By:.2 (Plot plan, showing size of lot, location of system in relation to�V74�- wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ---- DATE-------r<�--------------------------------------- --- - APPLICATION ACCEPTED ---------------------------------------- DATE_ "_---- ----- REVIEWED By--------------------------------------------- - DATE-----------•--- ------~----�------------------------------- ---BUILDING PERMIT ISSUED �----------------------------------- ----- ----��----- ------ ---------- ----- --- Alterations and/or recommendations:-------------------------- -- ------------------ -------------------------- t � • --- ---------••------•--••--•-------------------•--------•-- ------- - zo-------- --------------------------- ----�)----------------.............. --------------------------- ---------------------I-------------------------------- -------------------------------------------- ---------- ---------I---•---------- - ------- ---------------------------------- ------- FINAL INSPECTION BY:._`�_._.__ ___-_ ----------------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ' E5�g 145446 ATWOOD _ - -