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�ITIq APPL1CA710N FOR SANITATION PERMIT Permit No. ..--�-1--.---�f-� .. l< (Complete in Duplicate) Date issued - - ��- -- e permit to construct and install the work herein described. App + hereby made to the San�Joaquin Local Health Disfoc 549 a This a a ion is he y This application is made in comp4iance:w+#h County Ordinance N -------------------------- JOB ADDRESS AND LOCATION---------- - Phone---------------------•-----•-------- /n(�'r/' - -- -- - -------•----------•------------"-------- -----------------------"---- -- Owner's Name- .-- _ 7 Address1 !?.-. --------------------------------------- 41 Phone Contractor's Name---- -=------- Commercial ❑ Trailer.Court ❑ Motel ❑ Other ❑ Apartment House ❑ Installation will serve: Residence (� P / 'i�� ------ Number of living units: ---/-- Number of bedrooms __---Number of baths ---I--- Lot size ___.a--f}. Communit system ❑ Private Depth to Water Table _- Wa}er Supply: Public system ❑ r. Y y ❑ y , Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam. Clay Loam ❑ Clay ❑ �. No New Construction- Yes ❑ No N Previous Application Made: Yes ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public `ewer is available within 200 feed Material--- •�"-r�-�----- 'I Distance from foundation_-.--- - Distance fros_n nearest well_, - -- Septic Tank: Size- Ufa-------Liquid depth---- Capacity.. �a No. of compartments-__.- J Distance to nearest lot line--" ------• !i Length of each l'sne_-___-_ d Width offrench.---- .4�'-- Disposal Field: Distance from nearest well_._ ..-- - --Distance from foundation _- ----------- �� Number of lines----------- j--rr----- _--- Total length------ - '-f�.Depth of filter material ri Type of filter material---JA--- �� Distance to nearest well- -, ------ "-Disfance from foundation Distance to nearest lot line----- ------- 1 Seepage Pit: !%� e Size: Diameter-- .----- Number of pits:-----�--------- ---Lining material - ining material-------------------------- Distance - ------------------------ -- �. gals. Cesspool: Distance from nearest well-------=--- ---Distance from foundation--------------- Capacity- --------------__`___"•- Size: Diameter-i--- --------------------------------Depth"--=-. ------- " Distance from nearest building---------------- ------------------------ Distance from nearest well- ------------ ----- ---- ----- --------- -- -- ---------•---------------- ---- Privy: ---- ❑ Distance f nearest lot line_------- -- ---- - F -- Remodeling and/or--r--e--pairi.n. epairing {desF ribe) ------------------------------------- --- ---------- ------------------ -----.- - ------------------- ------- ----------- ------------- -1 -- •--------- --"----------------------- " lirepared this application and that the work will be done in accordance with San Joaquin County hereby ce ' that I have p P 3 ordinances, S }e la s, and rules and regulations of San.�aaquin Local Health District. ( wner an Contractor] '"1-.. ---------•------ ( 9 -- - (Title) B .. plot len, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. ( i' -= FOR DEPARTMENT USE ONLY ,._ # �-------------------------------------- APPLICATIONDATE---- -Z ` -----------•....------------------------------- ACCEPTED BY -- ---------��- DATE------ -------- •-------------•------ --- REVIEWED BY ------- ------------- v �------------------ ---- ------ --- ------ DATE ------ BUILDING PERMIT ISSUED._-----------------------------�� Alterations and/or recommendations:_...-.-.--. �� ----- -- T ----------------- ---------------------------- ---------- --------------------- -------------------- ---------- --------------- --- ------- ----------------- ----- -------------- Date-- FINAL INSPECTION BY---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street Tracy, California 300 West Oak Street Manteca, California 130 South American Street Lodi, California Stockton, California E5�9-2M 145446 ATWOOD 12-54 -