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APPLICATION FOR SANITATION PERMIT Permit No. ____/ (Complete in Duplicate) I Date Issued IVApplica4-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 ma0a in compliance with County Ordinance No. 549. 000i 4 gr�,P-f JOB ADDRESS AND LOCATION.1,�.,_J----N_!9.e A....#j.. ... ---- -------------- - _1A. ... ----------- x 7_ Owner's Name------- ------12-jula..:,n------------------ ----------------- -------------------- ----- PhoneL;;Aw,__1_,f__A'5_.'_J Address... -----fz_t`L ;L L ------------------------------------------------------------------------------------- Contractor's Name............ ----- ----------- ------------------------ --- PhonA �607-- ----------------1--_!7i�i------------------------------------------------ .....6 _,6 Installation will serve: Residence [-] Apartment House El Commercial El Trailer Court El Motel El Otherlai Avie 1le------------ Number of living units: -------- Number of bedrooms -------- Number of baths Lot size -- ------' Water Supply: Public system 2___C`ommunity system El Private 0 Depth to Water Table47,Pff. Character of soil to a depth of 3 feet- Sand Gravel El Sandy Loam El, Clay Loam [:] Clay E] Adobe Er'-Hardpan ❑ Previous Application Made: Yes M No V�Nw Construction-. Yes Er'No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C� Septic T Distance from nearest well,00.1%4_ .--Distance from foundation-A/."'.._..__..__.Material__.c-Ic-ci------------I----------- No. of compartmenls--I------------------ clep� --- --- --- Liquid -4 ---- ------ --------Capacity--- ------- Disposal Field: Distance from nearest well.................Distance from foundation---------- ---------Distance to nearest lot line----------------- F1 Number of lines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------- - -- --------Total length-____-__.-________________________________ - -t Seepage Distance to nearest well__01��--------Distancq,from foundation_ _____________.Distance#0 to nearest lot line-------*)__ Number of pits. ED -A--------------Lining material-i-11L- -------Size: Diameter -------Depth�`. ....e------------------- Cesspool: Distance from nearest wO-----------------Distance from foundation--------------------Lining material___.__..._-___._____.___.._.__--_____. Size: Diameter_ - --- ----- ...........Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well...... _---------------------------------------Distance from nea rest-building------------------------------------------ ElDistance to nearest lot line-------- ---------------------------- ----- - ---------------------- ---------------------------------------------------------------------- -7 mode' g and�pr.repalringdescri - --- ----- - -A - T ------------------------------------------ ----------------- ----------- ---- -------- ---------- ---- - --------------------------_--------------------7----- ------ ----------------------------------- -- ---------------------------------------------------------------------------- ----- ----------------------- -- - - - -------- --------- - - ---- ----- ----- - - ------ ----- certify - ---------I----her-------- rt-i.fyi.h,a-tI--have.-p.repar-e-d.-this-is__application-p.I-i-cati.o-n--and that-the work will be done in accordance-with San-j-Iquip-_C.o-u-nfy- ordina c 5 S e laws, and rules a .1 regulafjoqs of the San Joaquin Local Health District. (Signed)------- ..... S*.�-------- ------------------------------------------ f Contractor By:----------------------------------------------------------------------------------- - ----------_- -------- -- ---------------(Title)_-- t---' . .... ------------- -- (Plot plan, showing size of lot, location of system in relafiojo 61ilis,'build�Tis.�efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- --------------- ---------- ------------------------------------ REVIEWEDBY------------------------------------- -- ---- --------------------------- --------------------------- ----- DATE------ ------------------------------------ ------------------------------------------------------ DATE. -------- BUILDING PERMIT ISSUED----------------------------- --- ---------------------------------- Alterations and/or reco ndations:--------- ------ ------------------------------------------------------------------------------------ --------------------------- --------------- (-------- ----- --- -------------------- e ------------•---•-----------•---•_...-----------•--•----- NE........................ --- -------- ------ --------------- ----------------- -------------------- --------------------- -------- _0-------- --- ....... ...... . : /47 ----------&------------- -------------------------------------------------------------------------- ----------- ---------------- --------- ------------------------------------------------------.- ---------- ------------ ------------------------ ----------------------------------------------------------- --------- --------------- ------------------------------------I---------------------- - .. Date----- - --- -- --- ------FINAL INSPECTION BY:------ ------ --------------------------------- ----•.. ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD I Z-54