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'1 APPLICATION FOR SANITATION PERMIT Permit o. --.7._ q_r� (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 A - $ o Ale - s AND LgCATION -.--.-_- _ Owner's Name---------- •----`- n �, ------------------------------------ ---- ---- --------------- Phone Address........... rrf Contractor's Name---------- --- i�l / `------------------ ------•--- Phone------------- ---•------ Installation will serve: Residence �Apartmenf House E] Commercial [I TrailerCourt C-] Motel [I Other 0Number of living units: _I--- Number of bedrooms .__� Number of baths ----/__1Lot size _-Ad4 / -V ldO/ ---------------------------------------------- Wafer Supply: Public system Community system-l]---Private E]--Depth to-Water-Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B--'Hardpan ❑ Previous,Application Made: Yes ❑ No [1--New Construction: Yes 2—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well-11�04/ODistance from #oundation--. T,_�_�__.____-----1�1C�•_ No. of compartments --------Size_r4_°----C---------Liquid depth----------`--------- Capacity Y -- Disposal.Field: Distance from nearest well__/-1_P_�eZNstance from foundation------7- {...Distance to nearest lot line. th ul --�fer-mat . ___.N ----------------- goeacne_-- ------_- ._-_-.--Width of french .2-.V Type of filter material__--_ .Y. _�`R-De_p+h of lera ...... length- -_______ -�-! u�------------------- Seeps Pit: Distance to nearest well-/-'/--() _Rist ce f om foun\ ' n-_-..,3---�-.:-Distance to nearest lot [ Number of pits----------—-.------.Lining mat rial' ---'�--ems-.Size: iameter- -��..3.`-�----._.Deptn----•-..A�. i,.3---�---- -------- Cesspool: Distance from nearest well-.----___.--- -Dis nce from foundat --.-...Lining material--..------------Size: Diameter ----------- - ----Depth ------ .......... - - liquid Capacity gals. �•��- �:.,.�..,,.Dis.tanUeptr-omrnearest-well-:=�:�• 7ne'ar•e�t "---""`--- Distance to nearest lot line.-------- ( . Remodeling ar�/d/or repairing (describe):------- -:........ ....... ... -------- ---------------- ...--•--------------------•------------------------------------------------------------------------------------------------------- -------------- ------ -------•------•---••--------------------------•--•-----------------•-------------- •----- �l ------------------------------•----------------------------------------•---•---------------•---------------------------------••----------•----------•------------------------.-----•------------------------------- I hereby cerfif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ayes, and rules and regulations of the San Joaquin Local Health District. (Signed) --------------------•-------- --- ------- ---------------C --------- -- - ------------------ ---------------------- { er and/or Contractor) - $Y:---- ----------------- ---- ---------- ----------------- --------- ------- ------ ( )------ ` if P of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLIREVIE ED BY ACCEPTED BY --- ----' ---•------- ----- -----•--- DATE----- ---------- -------------------------------- REVIEWED BY DATE-------------- BUILDING --------- -- .:--------------------------- •-------------• BUILDING PERMIT ISSUED------. -- DATE. -------- Alterations and/or r atio s:. _ - -- ------------------------- •-------•------ --•-.---.. -. -- -------------------•-------•- ------------ --• ....... C .- i.� __ z FINAL INSPECTION -BY:.- ------------ ------------ Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E$-9 195996 ATWOOD