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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct an insta e work herein described This application is made in compliance with I -- ---.-----------.--.",.-L-.---- ._... ----C---o--unt-,ux,c !i-Zon,Ace�- b. 549. 549., JOB ADDRESS LOCATION ---- -. -..e------------- e -------------------------------------------------- -------------------------- Owner's Name - - Phone Acdress___�_ - ----------- Contractor's Name -------------------------------------------------- ------ -------- ---------------- I -------------------------------------------- Phone ---------- Installation will serve: Residence Apartment House Ej Commercial F1 Trailer Court [] Motel ❑E] Other El Number of living units: I---- Number of bedrooms _Z___ Numbe f,4aths 24--- Lot size --- stem El Private ?rt -------------------- Water Supply: Public system []-.Community system ife epth to# -2 W_ater-Table/I------ ft. ftam KClay E] Adobe E] Hardpan Ej T❑'V- Nf Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam Clay LL Previous Application Made: Yes E] No 19/ New Construction: Yes ['No ❑ t, TYPE OF INSTALLATION AND:SPECIFICATIONS: (No:-septic tankor cesspodl'-perriiifted'ifublic-Ai�wer is-available within 200-f-e-ef.) Septic ank: Distance from nearest 1111_111A_Cj.�__Distanpe�,from fou tion___-0-------- Mater)Lai__,A------ - - pv No. of compartments_.._._.-- - -------size- -- -----Liquid delith----_*--------------�: dpacify----- �s�_�:__ �: Dispos I Field: Distance from nearest well. lot 1•nes Of - -------- ince m oundation M_ ---.Distance to nearest Number of lines----------- Zline---- U t +of each ---- Width of tre & ;� n --- -------------- Type-o'f filter maferi Depth of filter material--- . --------Total length___._______---------------0 4N;C__ - - 120____________•_•- Seepage 20-----------------Seepage Pit.- Distance to nearest well--*-- ---------- from foundation_____'_ Distance to nearest lot line__.____________ ❑ Number of pits----------------- -----Lining material------------ __Size: Diameter----------__-------.Depth----------------------•---------- Cesspool: epth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation.__.____-___.__...- Lining material------------------- ----------------- -Size: Diameter---- ------ ----- -----Depth-- ------------------- --------------------- Liquid Capacity------- ---------------- Privy: Distance from nearest well------- --------------------------------------.-D;stance from nearesf...building------------- ------ -- --- ---- El Distance to nearest lot line___________________ ------------------------- - --------------------- 'A Remodd[ing a-hd/a re aLLi.._9_(0esc, ribe)--- ---------------------------------- -----------------_ .�Vo I --------------------- e /�----------..... g ------------------- --------------------------------- -------------- -------------------------------- ---------------------------------- --7-------- ---�Am ------------------------ ----------------------------------------------------------- ---------------------------------------------------------------------------------------- ------------- ---------------- ---- - I hereby certify that I have prepared This application and that the w&-k-will-"-b-e--done--in-accordance-,with--San--Joaquin---County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. V (Signed)..n ------------------------------------------------- ------------ -------(Owner and/or Contractor) -6, ---------------------------------------------(Title]---------------- ----------------------- ----------------- (Plot plan, showing size of 10t, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ,- --------N�-- ---- ----------------------------- ---------------------------------------- DATE V—----------------------------------------------------- REVIEWED BY-------------------------- - -------------------- ------------------------------------------ DAT ....M,t,----------- BUILDING PERMIT ISSUED---------------------------------- ------------------------- ---------------------------------- DATE--------°f Alterations and/or recommendations:---------- - ------------------------------------- ------------ r ------ -------------------------------A------------------ t q-------- -------------------------------------------- ----------------- -------..17!.--- ------- .1-4s -------------- --------x -------------------------------------------------------------- .1 - . ZI........P-4-r---- - ---- P --- ------------ ------------------ ------------------------------------------------ ---------------------- -- ---------------- - - -------- ------- ----4- --------------------- --- ----- - - ------- -------- ----------------------- ... ------------------------------------ -- ------------------------------------------------ ----------- ------------- V ---------------------------------------i---`-/---0- FINAL INSPECTION BY:- Date ? --- -7------------/------- --�-----------------3--------------------e 7-- ----------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod!, California Manteca, California Tracy, California E!3-9 145446 ATWOUD