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#31 APPLICATION FOR .SANITATION PERMIT .� Permit No. .__, (Complete in'-Duplicate) _ ' Date Issued ala ?A, plical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install fihe work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION......1_.__ Owner's Name , , ! ----------------- ---------- --- --------- -------------------------- ------ ------------------------- -- (l o ------ Address-----------------------•-• ---------------------- ---- ---------- ----------- Residence Contractor's Name hone •p-rtm----•- ---- -- - -----"------------ --------- Installation will serve: Residence A artmen House Commercial ❑ Trailer Court ❑ Mom ❑ Other ❑ Number of living units: I_____ Number of bedrooms___- Number of baths Lot size � 5- 1-7.t7 --------------•- Water Supply: Public system �ommunify system,E], Private[_1 Depth to Water Table '_._'_-- ft. Character of soil to a depth of 3 feet.' Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay [I Adobe� ardpan ElPrevious Application Made: Yes No ❑ New Construction: Yes Vg---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pulblic sewer is available within 200 feet.) Septic Tank: Distance from nearesf well__:__�/" istari #nom .foundation_ __ Mate,al 6d,- ------ Size No..of compartments _T-)(__4_T�Liquid depth__.____- .__� p ��-�--- Size--- -- - ----- Capacity-----� - Disposal Field: Distance from nearest well- 'fDistance from foundation._P fe_:...Distance to riearest lot line__ Number of lines........ - - "- --Length of each line---- of trench_.___ _:tk ` ` --------- Type of fiiter maferiai�� r """ �y -- Yp _.__ -_Depth of filter material__ "._ --.T otal length:- -� -- -- --- -- ------ G��Disfance Distance to nearest well________________--___Distance from foundation___-________-___-__.Distance to nearest lot line-_________..____!umber of pits.--- I ------Lining material-----------------------Size: Diameter---- ------------- ----Depth.-----------------------from nearest well !_.___.___::"-_Distance from fovndafion.- :: -._ Lining mat''aria)___------------------- I. ______- 6�. ,._ ❑ Size: DiameterDepth ---- ------------- -- -----Liquid Capacity------------•----- ---------gals. Privy: Distance from nearest well-----------------_ ___________________________ Distance from nearest buildin g / ❑ Distance to nearest lot line ___--.-_ " 41__-A ---- ------- --- Remodeling and/or repairing (describe):--------------------------------------- i ----•-----•-•---------- ------•--•---•--------------------•------------------------------------------- r --•----------•-------------•----------•-------------------------- --------------------------------------- ---•-----•-------------- -------•----------------------------•----. t ------------•------------ ----------------•------------------------ --------•-------------------------------------------------------= I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and r ulations of the San Joaquin Local Health District. Sept, & NIGHT , (Signed)------------- - ptic To k-Se - . 1706 Sc:lelif -------... -- -------------------------------------- or Contractor) BY:-------------------------------•------------5 = -------- ----- -----------------------(Title)---------- (Plot plan, showing size of lot, location of.system n_relati to wells, buildings, etc., can be 'placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..�:_--- ----------- - DATEle - REVIEWED BY --------- DATE---BUILDING PERMIT ISSUED - --------------------- ------------------------•--:--------- DATE--------tcN --------------- A terations and/or recommendations:-_.-------------------------- ' ---------------------------------------------------- .- . , r_ --------------- --- ----------•--------- ------ FINAL INSPECTION By ........... .- Gf • ------------------------------- ------- Date. -------- --- �..."!_,- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOUD 12-54 i