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APPLICATION 3=0R 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 LOCATION___________ __ _ -------- Owner's Name---- = -------------------------------------------------- ------------- Phone----------------------------------- Address-./ -��. 1V.: ...- --- ------ ----------------------••--------------------------..-------------------- ---•----- f 2 ------ Contractor's Name--' a. .._d � —._ ---- -- ---------- -------------•----------------- ------- Phone - - 4-14.... -•-• - Installation will serve: r Residence A-�Apartment House E] Commercial E] Trailer Court ElMotel ❑ Other ❑ Number of living units: J___-Number of bedrooms .I--- Number of baths A-__- Lot size _410__X--- ____________________________ Water Supply: Public system ommunify system ❑ Private ❑ Depth to Water Table S. ft. 5 Character of soil to a idepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe dean ❑ Previous Application Made: Yes ❑ No A___nevy Construction: Yes ❑ No L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r -4— T �- �. Septic'Tsnk:-^�~'� Distance from nearest. well_""'"':__'_'._:Distance from foundation___________________.Material_-_----_-.__.____________--._-_-______________... ti S A No. of compartments-------------------- ---Size------------------------------..Liquid de�th__-_------------•---____--capacity _ - isposal Field: Distance from nearest well_________________Distance from foundation-------------I-----.Distance to nearest lot line-_-_____________. ---------------- Number-of lines-------------------------•---------Length of each line----=--.---_-------_ ----.Width of french----------------------------------- Type ar filter material ______________ Depth of filfer Total length Seepage Pit: Distance to nearest weli�'��__Disfanc om foun ation-_ .��_'_..Distance to nearest lot line____- _�?__'__ Number of pits-------.-_ -------Linin mqe �- 4,ZA � p g -- ize• iameter ---------------Depth- `1J a f Cesspool: Distance from nearest well_________________ ce,from ation-___._______;_____.Lining material__.____._____._______-_____________..❑ Size:'Diameter-------- -------�.--------- - -------: '-"`= ° --..Liquid Capacity- -------------------------gals. Privy: Distance from nearest well--------------------------------"' ------------Distance from:nearest building------------.---------------------------. .a �. A ❑ Distance-to nearest lot (ane ------------------- --- -------------------•-----------•----------------I----------------------------- ------------------ ---------- fN ,`Remodeling and/or re airing ---------------------------------•--------------- € -„ --------------------------------------_._•� -- --------•----- 1 ------------ -------------------------•--•--------•-----------•-------------------------------•---------------•-••-------------------------------- ---------------------------------------------------------------=-----------------•--------•---•----•----------------------------------- i,hereby.certify.that I have prepared this application and that the work will"be done in accordance with San Joaquin County ordinances, S to laws, and r and regulations of the San Joaquin Local Health District. - r � Owner-&&.d/-ar--Contractor) �. (Signed)----- -- --- -- ---- - -------------------- ......- ------ ------ -------------------- { r By:-------- -- -•-- - •--- ---- - ----- `---`-----------------------------------------(Title) ---------------- - (Plot pian, 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----------------------------------------- 5----------------------------- DATE , --------------------- REVIEWEDBY-------------------------------------------- ----- ---------------- --------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------- --------------------------------------------------'-... DATE------------------------------------------------------------- '- --� Alterations and/or recommendations:-- ------------- -----------------�-------�---------------------------------------------------------------------------------•------------------ ••------- -------------------------- - �J ----------------------• ---------------------------------------------------------.. ------------------------- ------------------------------- ------------------- -------------------------------------------------------------- ----------------------------------------------------------- --------•---------------•--• I -------------------------------------------------------------- -------•-- ------------------- ---------•-------------------------------- ----------..--------------------------------------------------- ' � J / FINAL INSPECTION BY:. -------- .... ---- Date------ --- -y ) SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South 'Americ'an Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Sfockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOD 12-54 LN