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.,. A b�Permit No. .---�-_�`_...1_-.._ � �• APPLICATION FOR SANITATION PERMIT �O • "� /n 11 [Complete in Duplicate) Date Issued __--___ (�_&_!..'1� 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. ---0-�--- ----: Owner's Name----- �..............4 L. ------A/'a-----------------�--•------- ------------------------------------------------ ADDRESS AND �PCATION-------4> -------------------------------------- Phone------------------------------------ Address--------------- -------� / '-- / - `` t t Contractor's Name_______ �r h?` ----••-------------------- •-•----- Phone.V-,6 Installation will serve: Residence Apartment House - .ommercial [I Trailer Court L] Motel ❑ Other ❑ � Number of living units: _-_/___ Number of bedroom - °umber of baths .__-�- Lot size ____- - �`' -------------------- Water Supply: "Public system Community system El E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe o� Hardpan ❑ i. Previous Application Made: Yes ❑ No •. New Construction: Yes,E' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)I Septic Tank: Distance from nearest welL__Lf��1a.2D stance from foundation-_--�G4_....__--Material___ ------ _Qa No. of compartments Size:--5-6- -- Liquid depth.___ _. ---------Capacity--------��.0---- ' Disposal Field: Distance from nearest well-/, -7 �94stance from founda�t-i�on-.__ ____._. Distance to nearest lot line--__--- fJ-� � va � Width of trench____-: __ >� Number of lines--------,1____-._- F Length of each line--_ _ ._ 9.._..._...`.!_. - f--- / X- ----Total length----------,:bra----------------=--- Type of filter material____-__�__._��LiDepth of filter matenaL_.____�- P "*� tan prom foundation---- ---- --------.Distance to nearest lot line-___ e--�-- Seepage Pit: . Distance to nearest well---_/?1l, " � > r Number of pits------- ------- - - -Lining matCial _. � iam er------� ri--Depth- °n Cesspool: Distance from nearest well---------- ---_De froml. ada+icn------ -------------Lining material--.-_---------------------------------------------- -� .;Size: Diameter--- ---------- -------- Depth__ __ _ . •quid Capacity, -- --- -- -- -- Distance from nearest building_, ----------------------------------- Privy. ;_-------_________________________ Distance 'Irom st Priv❑ Distance to Barest lot`linle---------------------------------- y' _._ __. Rem Jelin and/or repairing (describe): ---- ----------------•-------------- �; g " - - --------------------------------- ------------------- --------- •-- --- `. -..J-------- = -------- --- A ____________ VV _ ------- ------------- ________ _______________________________ — ------ _. _______________________________T_________________.______.___ _____________________________________—___.._i�_e__.__._-. . I hereby certif have prepared this application and t at the work will be done in accordance with San ,lbq iuiu County ordinances, Stat aws, a rules and regulations of the San Joa�U'.. Local Health District. -(Signed) '/ ! � -- ------------ ��[Ow er and/or Contractor] BY: - (Title)------ . .....----------------- --- - -- ---6Z.). (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY- •-------•----- ---------- DATES--------------------------------- ----------------- REVIEWEDBY--------------------------- --- � --------- ------. ----- -------------- ------------. DATE - BUILDING PERMIT ISSUED_ - - DATjZy E ------------------------------------------------ Alterations and/or recommendations-------------------------------------- -------------------------------------- =----------•----------------, --•-•--------------------------•---------------•--- -••----- •.------- ----_-- - - .. � -------- _ -- -- -- - ,` --•• x ��.e ` `� .. .C. --------- Date.- --------------- ---~'- ;- N. FINAL INSPECTION BY------- ---- -------•-----•- -------------. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street California Lodi, California Manteca, California Tracy, California Stockton, 4 u F5-9-2M 145446 ATWOOD 12-54