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-•� � Permit No. _ - .___.____ PLICATION FOR SANITATION PERMIT v } (Complete in Duplicate) - Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to nstruct and install the work herein described. _ - This application is made in compliance with County77�yy,/Ordinance No 549. r' - 5-"'___ A _•t .---•-------------------------- -- ___ "----------- JOB --" - JOB ADDRESS AND L CATION_______ - Owner*: N e._ ne. ----------•-- = = JY Address.. •__ t _- Phone---.; ----_ 0- T -- -• ----- - ---------�-------------------- ❑ ❑ R Contractor's Name .--------- • ----...- _ .__- ---------------------- lnstallation will serve: Resi encu Apartment House - mmereial ❑ Trailer Court E] Motel Offer f Number of living units: ___�.- Number of bedroo s --- umber of baths . --_ Lot size ______ - -- - - = ----------------•- � ft. Water Supply: Public system Community system, rivate ❑ Depth to Water Tabl�____ Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam ❑ Clay E] Adobe Hardpan E] i Previous Application Made: Yes ❑ NOX New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: // `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----.M �eri I ---- s�--- --�--- ----- Septic Tank: Distance from nearest well.' ._.Distan e from f un'da1tion__- - Ca acit No. of compartment.__.____----------Size_-.,,'-� �}' �i uid depth . - -- P Y• f __Distance from foundation__ . �-____-._-Distance to nearest lot Ii�e----»�__,--- r Disp sal Field: Distance from nearest well , / W Width of trench. _ _ Length of each line------- �----.------ ------------------------ 4. Number of lines----- --_.--------- --- -- --- g Type of finer material _ __. . -- ----Depth of filter material_-_---/_ __'! Total length__--__�Q-- ------ r Seepage Pit: Distance to nearest well--_------------------Distance from foundation_-_-___ --__._..Distance to nearest lot line-______-______-_ ❑ Number of pits----- ------ -- ---Lining material----------------------- Size: Diameter-----------------------Depth----------------- _._, „. aeras*we -_----- - ---- i nce�fronounaationL�rrinclmateriaL -- --- ----- ------- ----- ' esspool^ `"" "''i?istance -Li Liquid Capacity _________.gals. ❑ Size: Diameter .-------------------- --- ...... --- Depth q p Y: Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- Distance to nearest lot line--------------------- - ----• ------ ----- ---- ----- 1 � t El Remodeling and/or repairing (describe): ------------------- --------•---------••-----•- •--------------- -----•------------------- ---------------•--------- -------------------------------------------------- -------• ------------------ ------------ •------••-------------•-•-----------•--------------------------------------- -------------- - .--- -- I hereby certify-that I hav prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and u s d regulations of the San Joaquin Local Health District. Owner and/or Contractor) Si rigid -tle)- - - ------ ---------------------- 9 {T� { By:-------_---------� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pi d on averse side). - I cFQR DEPARTMENT�USE ONLY _� C APPLICATION ACCEPTED BY------ -------------------- -- -- --------- -----------------------------------•----------- DATE DATE------------------------------------------------------------ REVIEWEDBY--------------------------- ----------------- --------------------- ------- ---- ------ ----- DATE--------------------------------------------------------------- BUILDING'PERMIT ISSUED-------------------------- -------------------------------------------------------------- ----------------------------•----------------- Alterations and/or recommendations -- ------ -- -------- - -- _ c -- ----•---- ------ . -- ---------- ------------------- - _._.__.. --� ------- ` • --- •----- -- ----------•--- C - Date- _ .-,:, � . . FINAL -INSPECTION BY--------- - ------ ---------- - ----- , .�: Y R i r AN 'HDISTRICT' rth "C" Street 130 South American Street Wast Oak StrfOCAL 132 Sycamore Street 814 No 4 Manteca, California Tracy, Celiforaia " Stockton, California Lodi, California 1',. Es-9-2M 145446 ATWOOD 12-sn