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APPLICATION FOR SANITATION PERMIT Permit No. ----- 13 33 (Complete in Duplicate) Date Issued Applica;ion is hereby made to the Son 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. -_70 a JOB-ADDRESS AND LOCATION----- -_ --., -A ---------------------- -- ----------------------------------- Owner's Name----- ------ ------- ---1Phon)el --------------------------------- A) Address.............. ------------------------- ------ - --------- ----------------- ------- --- Phone..--------------------------------- Contractor's Name-----••--------- ___ I C-_ A� ------ Installation will serve: Residence t__ZPar+menf House F] Commercial E] Trailer Court E] Motel 0 Other E] Number of living units: J--- Number of bedrooms R__ Number of baths __R__ Lot size ----A.- E] ----------------------- Wafer Supply: Public system -,Community system Private gq-'Depth to Water Table 4 n ft. $f A-01 Character of soil to a depth of 3 feef', Sand Ej Gravel E] Sandy Loam E] Clay Loam El Clay 0 Adobe 8- H- arclpan'[] Previous Application Made: Yes 0 No ,New Construction: Yes ?�,�o E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspoolpermitted if public sewer is available within 200 feet.) te ial----0-6----------------------- ------- - f n e fl-orn foundation----&'V---------Ma r Septic Tank: Distance from nearest well Dis a c No, of compartments._._A- --- ----------Size--------X..V-f-----Liquid depth--------------------------Capacity-------------------�= � ,� f.,.r. Disposal apacity-------------------- Disposal Field: ....Distance from foundation---: -------- Is a Distance from nearest D' t nce to nearestJot lineX;_�__ Number oi lines-----------------------_--__--- jLength of each Iine11bP_'F__4,X-4WV�idth of trench---- ---------------------------- Typ ' filter materiaI__/_;�,-, t " or Type of _�_,e[D�pfh of filter material.... Total length---------/ -------------------------- Seepage Pit Distance to nearest�,ll...... --Distance from,founclofion__.t&.._.....Dista ce.to nearest lot line---�0� Number of pits...... ------------Linirg mate ria e: Diameter.... Depth------ ;_�A*?_------------------- Cesspool: Distance from nearest well---------------.-Distance from fou'riclafion............."..._..Lining material__"-_____________._ - ,a4� 171 Size: Diameter'__------------------------------_Depth---------------------------------- --- ---- ----Liquid Capacity----------------------------gals- Priv apacity----------------------------gals, Privy: Distance from nearest well--------------- ---------------- ----------Distance from nearest building.----------------------------------------. ----------- ❑ Distance to nearest lot line-------- --------------- -------------------- ------------- s. f _4? .-:, � Remodeling and/or repairing (describe):----------------6 k- -- - ------------- ---------- --------------------------------------------------------------I--------------------------------------------------------------------------------------- ------------ ---------------------------------------------------- A ----------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------- -----------------------------------------------:----------------------------------------------------------------------------------- -----------------------""----------••------------------------- I ---------------------------I---------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County f�ri ------------ ordinances. State laws, and rules and re Llafions of the San Joaquin Local Health District. i6_ . .......... (Signed)......-------- - ------ -1'e ----- ----------- ------------------------ --------------- B -(��/_Qr Contractor) By:....-------------------- --- ------------ ----------------------------------------(Title)------ .1 ------------ 4Arc_14�00�4 ------- f of, location of system in relation to wells, buildings, etc., can be placed on r (Plot plan, showing size 17 everse tiffe). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- Ilk, - ---------------- ------------------------- --------------------------------- DATE---------;�: -------------------------------•--------------- BY--------------------------------------- ------ --- ------- -------------------------------------------------------------------- DATE------------. BUILDING PERMIT ISSUED------------------ -- ------ ------------------------___-------------- --------------- DATE------------- Alterations and/or recommendations:.------ ---------- ----- �\_y---------------------------------------------------------------------------------------- .....q ------------------------- --------------------------- -------- ----�4--------- ----- --- --------- -----------r-------------------------- ----------------------------- --- ----- T.�k' �n ---- --- _,;;� ........... --- - - -- - - -----------------------1----------- ---------------------------------------- -------------------------- ------- ------------------------------------------- --------------------------------- -------- -------------- --------------------- -------- ------------------------------------ -------------------- --------------------------------------- ------------ -- -------------------------------------- ----------------------------------- ------------------- FINAL INSPECTION BY:.. -- -- - ------------------ ---------- Date- SAN JOAQUIN LOCAL HEALTHIPISTRICT 130 South American Street 300 West Oak Street 13 $14 North Street nore Street Stockton, California Lodi, California Mantecail,&litornia Tracy, California 145446 ATWOOD