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APPLICATION FOR .-ANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica-lion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. --- - -- -- -- -----------------------------------4_................ JOB ADDRESS AND LO;ATION-:- -4 --------- ----- - --------Vre'-K - -- ------------------------ - -- - Owner's Name----1'V x-d-gr-f�n........4-----*a*4L_4.................. ......... -------------- ------------------------------- -------------- Phone------------- Address----_&4_I :---�--x_�t � Q_-�\-,---- ......----_-------_---------------------------------------••--------------------- --------------------------1--------------------- ---------------------------------------------------4-----------�- - Contractor's Name.. �_ �4--- -----•---•--------------•-------------- -------—----------------------- ------------------------- Phone- q Installation will serve. Residence 5?/Apar+ment'House E] Commercial [:] Trailer Court E]—Motel El Other E) Number of living units: ---1,Number of bedrooms _-_1_--- Number of baths ---i---- Lot size -- -------------------------------- Water Supply; Public sysfem'g Community system El Private E] Depth to Water Table 4-(--'ft. Character of soil to a'depth of 3 feet: S d Gravel Sandy Loam Clay Loam E] Clay E] Adobe O/Hardpan El Previous Application Made: Yes [] No San Construction:[I ;W'jNo TYPE OF INSTALLATION AND SPECIFICATIONS:. k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n Sep;t-rT k: Distance from nearest well-_----_--_--.---Distance from foundation---- ---------------Material------------------ ----------------------- ,y I No. of compartments--------------------- ----Size--------------------------------Liquid depth---------- ---- - --------Capacity--------- ------ Disposvi Field. Distance from 'nearest well.,60...... .Distance from foundation---i f -.---.Distance to nearest lot line-------------- --• Number of lines-------L--------------------------Length of eachL.line--------30---------------Width of trench... ------ --------- Type of filter materialr[Li-el----------L.-Depth of filter material--- -----..Total length-_--.--30---------------------------- .Seepage ength .3-0- -------------------------- .Seepage Pit: #Distance to nearest well----------------------Distance from foundation---------- ---------Distance to nearest lot line-------..__._---_ ❑ ine----------------- El Number of pits- --- ----------------Lining material-----------------------Size: Diameter---------- -- ---------Depth----------------------- Cesspool: Distance from nearest well----------- ---,-Distance from foundation--------------------Lining material--..---------;.-______-.-_.--_--- F1Size: Diameter----------------- -------------------Depth---------:---- -------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from ,nearest well---------- --------- --------------- ------- ---- --- ------------Mstance from nearest building-------------------------- F-1 Distance to nearest lot line----------------- ---- ---------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describeJ: ---------------------------- ----------------------------_ ---------- .......... ------------- ---------I---- - ---------------- ------------------------------------- -----------__1--------------------1--l-i-------------2------------------- ----------------------------------- --------- ------------ ----------V -------------------------- ----------------------------------------- ----------------------- ------ --------- ----------- -------e- I here.by certify that I have prepared arA this application and that the worVwill be done in accordance with San Joaquin County ordinances, State laws, and rules a, regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signed)- ----------------------------------------------- ----- ------- - ---------I----------------------------- -- --------------------------------------- By:--------- - ------------- --- ----------------- -------------------------------------------------I---------------------- cy-I--A--------------------_ I (Plot plan. showing'g iz; of lot, to tion of system in relation to wells, buildings, etc., can be placed on everse side). ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------ DATE---------- _1_�k ---------------- ---------- ------------------- DATE---------- ------------------------------- REVIEWED BY------------------------------ --------/ r ----- -- ---- 4A ---------------- DATE------------------------------------------------------ ...... BUILDING PERMIT ISSUED----_----------- ------------------ 'ns:__V11 ----------- -------------- - ---------------- --------------------------------------------------------------- ------------------------------------ Alterations and/or recommendatio -------------------------------- ------------------------------ -------------------------------------- ---------------------------------------------------------................ ---- -- -----------*-------------------- ------------------------------------------ --------------------------------------- ------- ------ ---- ------------------------------------------- ------------I--------------------------------------------------------------------------------------------------- --------------------------------1 . ------V -------------------------------------------------------------------- FINAL INSPECTION B --------------------- ------------------ ------------------ Date--..... --------------- --------------- --------------------------------- ------------- -- ------ -------------------------------------- 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 V Es--9-2m 195446 ATWOOD 13__