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G I� APPLICATION FOR SANITATION PERMIT Permit No. ...`??_�v---•---- omp �I (Clete in Duplicate) �- S G .� Date Issued - ------- pp -------------- A lira+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wodherein described. This a lication is. ma/d�e in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION— } � ------�'-4------------------------------------------ Owner's Name ----- d r-.c>.-•.•?--.�--- Phone Address------.41r � ��=� ---------- , _ - --------•- --•--- Phone----------------------------------- CN,) Contractor's Name-.A&-.-- """ ' Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other L] Number of living units: --__--_ Number of bedrooms ........ Number of baths -------- Lot size _ 1 ____ _r '--. ------••---------"-_-- df Water Supply: Public system [[a�Community system El Private ❑ Depth to Water Table ft. Character of soil to a depth�lof 3 feet-. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan 0;t)ll Previous Application Made:"Yes ❑ No W?"'rNew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 i Fpt•s N � from nearest well ------.Distance from foundation--.-------__ _-_ ..Material__._"---....._--------------------------------- & c �io. of compartments-------------- -------- -Size--------------------------------Liquid depth------------------------ -Capacity from nearest well-..---- --------------------Distance to nearest lot line-__---.___.". .- Up!sI,Fie!d: Distance Distance from foundation Numberlof.lines---------- ---------------Length of each line----------- -----------.-------Width of trench.---------------•------------------ Type of'Ifilter material-------------------------Depth of filter material----------------------- length----------------------------------- E Seepage Pit: Distance to nearest well-._."Distance from foun ation-----/6...___.Di ---- to nearest lot line-�p_ Number`of+pits-------- -_.__---_--Lining mater--sal_C-6-4�ize: Diameter- ..____...___Deptn._.__ o`._---_- p I Cess ool: Distance from nearest well----------------- from foundation....................Lining material__.:..____.._"__.._..__..._._____._.: ❑ Size: Diameter-------------------------------------Depth---------------------- --------------- -------------Liquid`Capacity -- -� •-�---�---gals. Privy: Distance from nearest well---.--..---------- ------------------------------Distance from nearest building---------------------------- -- ❑ Distance to nearest lot line.. -------:------- `-- ---------------------------------------------------------------------•--- _. rte" J -f - ....--------'------------------------------••----•--•--------•.....-. Remodeling and/or repairing (describe ______________ _._.__.___._.__..._____ � ' � r --------------------------------------•-••------------------------------ ------------------------•------------ ----------------------- ------------------------------- --------------------_----- ---------•-------------•-•-----------------------------------•--------------------------------------•----••----------------------•--•------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ° ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed]..-------- �� - i� - act Contr or) (Title)--- BY OOW Plot plan. showing a of lot, location of system in relation to wells, buildings, etc., can be placed on never side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._.. _- PATE ---��---"------------------------------------------ REVIEWEDBY-------------------- - -------------- - .� ------------ -- --------- --------------------- DATE --- -._ --..---------•---------- DATE--------- ,, -----------_---- I q�j PERMIT ISSUEDrecommendations: ------ -.-- - '- -� --�- ---=----=----------•"------------------ ----------------•--- -----:--- ----------•------------- 1 --- - _ ------------------------•----------------------•---------------- Cera cans and/or recomm ----- .' -------------- ----- ---- -------•-------- ------ --------------- ----•----.... _ - � Date-- FINAL' INSPECTION BY..-_ - -.-.- - ----- x ---•----------- ----------- II - ii SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Strelet 30D West Oak Stree{ 132 Sycamore Street 814 North "C" Street Stockton, California `! Lodi, California Mentees, California Tracy, California rS-9-2M 145446 ATWOOD 12-54