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M / APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---M- _�o - + to the San Joaquin Local Health Dist ric fora �errnitrto construct and install the work herein described. Appllca ion is hereby made q ,11 41—Cl This application is made in compliance with County Ordinance No. 549• CL , � z 7 ' l1q.1 JOB ADDRESS AND L ATION._ -9y-- o -..h_...___-.____.. ------------------------------------------- ---- Phone-- --------------------------------- Owner's L�Name•. !!__.••-nn..��----- �'�------ ,I Address---- s----•--�•� -7- ----- - •-=------------------------ ---------- -----------------------------------------------------•----------------------•------------------------------- tsa,•,�~ ------------ Phone----------------------------------- Contractor's Name----D_�= t'hJL` u '�`"".`. ---------- -:------- - Installation will serve: Residence ❑ Apartment House 29 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r .� Number of living units: _.I Number of bedrooms ---�--- Number of baths ---.Z._ Lot size ._.. ._ Water Supply: Public system. Community system ❑ Private [g Depth to Water Table - ' ftp' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3\ Hardpan ❑ Previous Application Made: Yes ❑ No [a New Construction: Yes ❑ No [& TYPE OF INSTALLATION AND SPECIFICATIONS: '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: m stance from nearest well-----------------Distance from foundatiLn_U-d clepth._Materia- Capacity----------.---_-------- ❑ �G�jo. of compartments------ - ------------ Size- ------------•------------- 9 Disposal Fieri: r Distance from nearest well_.__...___.__..-Distance from foundation--------------------Distance to nearest lot line---_._-_---.--_. -Length of each line---------------------------- Width of tranch_.___.__.---.------------- ❑ ��umber of lines------------------- ----- g Type of filter material_-..'-- .-----�------Depth of filter material-----------------------Total length--.--------___--t line ,J ,---_.Distan re to nearest lot line..___r___ Seepage Pit Mance to nearest,well---/.��:---------Distance from foundation__--._____ _- Depth__....�r�-- ' umber of pits..__.-�.---........Lining material-t,'e- Size: Diameter..__. __._�_ - Cesspool: Distance from nearest well-----------------Distance from foundation._ ._____..Lining material----------------------------------- ale. ti ❑ Size: Diameter-------------------------- .........Depth - --------- I Privy:' Distance from nearest well-------------------------- ------Distance from nearest building-------------------------------•-------- - ❑ Distance to nearest lot line----------------- Remodeling and/or repairing (describe)------------------------------------------ -------------- --------------------------------------------------------------------------------------------------------•-- uy ! herebycertify that prepared application J that work will een accordance with San Joaquin Con ordinances, tatelawsand ulesanregulat ons f the San JoaquinLocal HealhDistrt r. _ ( ner and/or Contractor) ( ---- ---------•----- -------'----------------------- Ow (Signed)g ) p ------(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 T w APPLICATION ACCEPTED BY -•-- ------=_ ----------------- 'DATE= - - REVIEWED BY-------------------------------- - -- DATE__. __ BUILDING PERMIT ISSUED.-------- ..--'----------------- 19^-----------•------------ ----------- --------- Alterations and/or recommendations------------------------------ ---------------- -----------••-------- ----- - - - ----- -- ------ --------/ ---------------------------------------- --•---------------------•-----•-----------•-------------•-- - ----------' ------------------- --- A)- -- ------•----•------------- ----------- ------------ --- ------------------------------------------I-- ----------- ---------- ------------------------ - ------------------- ----------------------------------------------••----------------------------- __ ---------------•----------- FINAL INSPECTION BY..- ----------------- Date----- --------��-�---- ---- ---- ---- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y' LS-9-2M 145446 ATWOOD 12-sa