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APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) Date Issued 2_:76:z5 o"- -N- s•nQ--7-;ilj .Z C4+_r_)A X`4 D(0? 024 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 ` 9 JOB ADDRESS LOBATION_------ --- --- ---- --------- -- �-------- -------- -- Owner's NaRaa - -------- ------- ----------- --- ---- ----- Phone. x -r__--------'-----•.- f Address -- -------- �----- ------- -- --------•-•- :.. , --- Contractor's Name ----=---•--------- -------- - ------ Phone f= _ _ "-Co"lation will serve: Residence'❑ Apartment House ❑ Commercial Tra•ler Y 0 otel ❑ Other ❑ , Number of living units: -------- Number of bedrooms ------- Number o e -- Lot size ____________________'-__-__________.--------------------- Water ter Supply: PublicsY stem 11Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - ®_ (..o.septic¢tank_or cesspool permitted:if-public sewer is_available within 200 fe't.)1, - Septic ank: Distance from nearest wellU1/__ istance from foundation- -------`-- Mater; l_I x.__ .. 00 No. of compartments-----------�-- Size-----•--------------------------Liquid cjepPti+�---.-----I------ ----Capacity istance from foundation_ -. '� - "Distance to nearest lot line.___ ____.... Dispos. Field: Distance from nearest well/00 --.- � ------------- Number o4 lines--------- -----K0.--.. Length of each line--------------- tj ---Width of trench.--------- . �------- ------- � Type os filter materi +Depth of filter material____...___ ------Total length___________ __________________ wel{__________________ _Distance from foundation_--_______.!___-.Distance to nearest lot line--______________ Seepage Pit: Distance to nearest ❑ Number of pits------:---------------Lining material------------------------Size: Diameter-------------.---------Depth-------------------------------- Cesspool: ------------------------------. Cj Cess ool:El Distance ce f rom nearest well ---,-Distance from foundation•_,---.___-__:..___Lining material__..____..._-----__.____._____-__._. p t Liquid Capacity gals. Depth_ - ;._: L� ._:.� _ - - .� Privy: Distance from!nearest well------------------------------------------------ istance from nearest building-------------.-----------------•---------- ❑ Distance to nearest lot line------------------------------.� ---------------=------------------ ----=`--------------------------------------------------------------- Remodeli g ja' d/cr repairing (d scribe:_ ------•----- � - ! hereby certify that I have prepared this application and that the work will be done in accordance with -- --------- ----------------- --- --- ---- ------- -- - ------- - -- ------------------------------• - q San Joaquin County ordinances, Stat laws, and. rules and re ulati ns of the San Joaquin Local Health District. O ner and/or Contractor) (Signed)_ --- --- - -------------_ ------------------------------------------------------- - .� - (Title} = f �.. �.. - -'� °--N (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,E..can be placed on reverse side). a' FOR DEPARTMENT USE ONLY DATE -- APPLICATIONACCEPTED B -------- -------------------- ------- ---------------------------------------- �� REVIEWED BY--------------------------- -------------- -------------------------- DATE-- ------------• •----._----------------------- BUILDING PERMIT ISSUED_____________ DATE-------- . _____ Alterations and/or recommendations: -- - ------------------------------ - --•------•----------------------•----------- ;t •---------------- - •----•------------------------------------------------------------- ----------------------- --------------------- -------- - -------------------- FINALINSPECTION ------------------------------------ Date....-- --------- -- --------- -------------;F1------ ------------ SAN JOAQUIN LOCAL HEALTH D1 RI 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California .y. �E5---9-2M 146446 ATWOOD I2-54