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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- Applica+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 made in compliance with County Ordinance No.-549. JOB ADDRESS AND LOCATIgN--- _c -------------e A-) 4) ...4---it f f //, 1/ ------------ --- --------------- ----------- Owner's NamelXW V "C/ ----------------------------- -------------- Phone.----------------------------------- Address----------------3,2-x -IK -C-7. 0--IV--------f.1-------------------------------------- ----------------------------- --•-•----....- ------------ Contractor's -------- ----------------- Contractor's Name------ -------X---- ----------r1c_Z-------------------------------------------------------------------------------- Phone/,_-0_._4f,0Z------- V Installation will serve. Residence E] Apartment House E] Commercial El Trailer Court [] Motel [-] Other ne*aI/O as E Number of living units: Number of,bedrooms Number of baths ---- Lot size ------ ----------------------------------- Water ------------I-------------- Water Supply: Public system C1 Community system El Private UEr"Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel C] Sandy Loam [] Clay Loam E] Clay E] Adobe [B--Hardpan E] Previous Application Made: Yes E] No [ New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) I-, Septic Tank: Distance from nearest- well-,-4-0--- Distance from founclafion,/OPIA _.Material--!q-----......ek---C-------------- N6. of compartments----- P_,__Size__s-�--,r r --4--? Liquid depth-------`. ----.---Capacity.._ ---------- e 10, Disposal Field: Distance from nearest well-_74- _Distance from foundation-----MA_sY Distance to nearest lot line %.I---------- Number o� lines--------------- ----------Length of each line_ _ Width of french---------9-_V_ -------------- W-1, I - J ---------- I ----- Total length___.____ ___P-------------- Type of filter materia --- ...2e------- -----Depth of filter material See ion---�!�_!!�nistanc ------ Pit: Distance to nearest well _/AA---------Distance from founclaf ,,p to nearest lot line -------- Number of pits._____.._!�----------Lining material---&.o�'CX�---Size. Diameter.......? ----------Depth------ -00------------------- Cesspool: Distance from nearest well-------------__-Distance from foundation-------- ----------Lining material------------------------------------- 0 Size: Diameter----------------------------- -------Depth----------------------------------------------------Liquid Capacity-.-----------------------.._gals. Privy: Distance from nearest well..-.-------- - ---- -----------------------------Distance from nearest building-.---------------------------------------- F1Distance to nearest lot line----------- ----------------------------------------------------I------------------------------------------------------------------------------ Remodeling and/or repairin (describe):__ F-Toezv-- 7---C ----------_5'-0_ x----V---r---- ----------I....... --d -------------------------------------------------------------------------------------- --- ------------------- ------------------------__--------------- ---------------------------------------------------------------------------------------_---------------------------------------------------------- -------------------- -----------------------------------------------------------------------------------------------------------------*-------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 5, and rules and regulations of the San Joaquin Local Health District. (Signed) (71---------------------------------- ---- - -/ ------ ---- --------------------------------------------------- --------- -------( n r and/or Confrac By:_.A& --------------------------------------(Title)--- % --------------------------- (Plot plan, showing size of-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- ----------------------- -------------------------------------------------- DATE-------5;-------------------------------------------------- REVIEWED BY-------------------------------- --- -------- ------ ------------------------------------------------- DATE--------- ----------------------------------------------- -- ----------------------------------- BUILDING PERMIT ISSUED----------------------------------- ------ ---- ------------------------------------------------ DATE--------------- ------�.F 1Z Alterationsand/or recommendations------------------- -- ----_- -- .---------------------•----------------------------------------------------- ------- ------------*---------- _________________________ ------------- ---------------------------------------------------------- ---------------------- _f---- Z -------------------------_-- ----------------------------------------------- --------- -------- -1---- ------------------ ---------- -------------------- ------- ��_-6�-t6-------- 'r�C,►. ----------------- ------------------------------------------------- - ----------------------- ----------------------- ------------------------ ---------- ------------------------------- ------------------------------------------------------------ ------------------------- ------ --------------------------------------------- ------------------------------------------------ ------ FINAL INSPECTION BY-- --- ------ -- ----S----------------------- - ----- 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 ES-9-2M 345446 ATWOOD 12_54