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APPLICATION FOS,, SANITATION PERMIT Permit No. L_ iry (Complete in Du licate, � A A I f Date Issued Applica+ion is herebymade to the San Joaquin Local Health q ea h 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 AND LOCATION. --------- -------- r Owner's Nam _ � _^.,._�_. .. A____'7' __ 1 _ - - Phone ! -': Contractor's Name- ----- --- --- = �-7 _/-_/ • e Installation will serve: Residence A arf ent House Commercial Y P � ❑ ❑ Trailer court ❑ Motel ❑ Other ❑ Number of living units: __ -- Number of bedrooms_ -_ Number of baths ---/-- Lot size _ Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table,��-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adol)ejv Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes-X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + [No septic tank or cesspool permitted if public sewer is available within 200 feet.] ,/�6eptic Tank: Distance from nearest well------------------Distance from foundation-------------------.Material___--.-___-_._.____-.._-__.--.-___- ------------ C� rNo. of compartments------------------------- Size--------------------------- JLiquid deph. - --- Ca acit Y----------------------- spisposal Yield� Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_.--.___--------- C/ Number of lines----------'------- ------Length of each line------------------------------Width of trench.----------------_.._-- - -- `^ ------- Type of filter material___________________ Depth of filte/rm terial------------------ _' Total length------------------------------------------ Se e Pit: ,. Distance'to nearest well.... --__-__Distance fromndafion�..a_ . !!' Dis ante to nearest lot line_____ Number of pits.- -__ _Lining materia�.��_� Size: Diaeter,_� Depth------��_,�' \�J Cesspool: Distance from nearest well-__-.__..__._.-_Distance from foundation----_-___-- Linin terial------------------------------------- --------------- ._.____._____________________ El Size. Diameter Depth ;- ------------Liquid Capacity--------------- ----•--gals. Privy: Distance from nearest well_-__._.________________________--.--._____.__..Disfance from nearest building____-.._-----..______._.-_____-__---__-_. ❑ Distance to nearest lot line- -- -- --- Remodel`n and/or repairing-(describe :..___f.� __. _�� -_ < c: �_ <'_ ,C I - ----- - L ---- --------------------/ify"that -----------------------•--- ------------------------------------------:_ ---------------------------------•------------------ -------------------------- -------------------- I hereby caI have prepared this application and th +he work will be done in accordance with San Joaquin County \\ ordinances, State laws, anti, rules an -r ula+ions of t a San Jo gainocal Health District. �\ Si ned �f�f� ,• _ t- --- ----'---• --(Owner and/or Contractor) B '.- �"/ Y• --------------------- ----------- -------- -------Ti+le <_�:�. [ � -s "---=------------ • (Plot plan, showing size of lot, location # system in relation to wells, buildings, a+c., can be�pleced on reverseside). s R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- _______ D E_.- --------- --------------------------------------------- REViEWED BY --------------------------------------- -- DAT -----�/-.- - -----------•---- BUILDING PERMIT ISSUED-------------- DAT �_. .__ ---------•--------------------- ---- - -- - =---- ` and/or re o �� w_ '� r r ` .l .moi _ - v /Z- Alterations j _ j F.:: _ ! ----- -•---•------��-.....__ - - el .r - - ____.____ _ _ _ 7 y __ FINAL INSPECTION BY f Pate _.. . - '� E _.. r ---- ----- J' SAN JOAQUIN LOCAL HEALTH•ISTRICT � 130 South American Street 300 West Oak Street 132 Sycamore Sfree9 Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M 145446 ATWOOD 12-54