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[ l APPLICATION FOR SANITATION PERMIT Permit No. _-.,/lll_ f`'!_•--- �•- : � _ ._. (Complete in Duplicate) . ll) Date Issued ______ _� -�3-_-• Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549. . ..__ t ., -•-------•---'•----------------------------------------------------- JOB ADDRESS AND LOCATION______ ______ ___ Phone.,. '�* `�`---4 Owner's Name---- -�r[!• •---- -- t'' ---^'��-..----- Address._ 33 3 4-(l ,IJP--IVIV-'• ---------------------------•---------------------------------------------•----------- --------------------------- Contractor's Name-------- --- • � A'. 4r ------------- -----------•--------------------...- Phone Commercial Trailer Court [3 Motel ❑ Other [_1Installation will serve: Residence Apartment House ❑ C ❑ Number of living units: '_`- Number of bedrooms . ._ Number of baths /.-__ Lot'size ----Sd--- -� Q-------------------------- Jj Water Supply: Public system ] Community system F1Private E] Depth to Water Tableft. Character of soil to a depth of 3 feet:, Sand [IGravel E] Sandy Loam E) Clay Loam ❑ Clay ❑ Adobe ' Hardpan [3 Previous Application Made: Yes ❑ Nox New Construction: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: € (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ETank: Distance from nearest well__ ______________Distance from foundation______-_.___-4.....Material-------------------------------------------------- - i- Size--------------------------------Liquid depth------------- ------------Capacity No. of compartments.__-, l' field: Distance from nearest well__.__-_'...._Distance from foundation------------------__Distance to nearest lot line--------- Number of lines------------- ------Length of each line----------------------- -Width of trench---------------'------------------- Type of filter material-'--------- --------Depth of filter material---------------- ----rotas length---_---------------------------•---/ Seepage Pit: Distance to nearest/well�_'MDistance from four tion-__ 42.'----.Distance to nearest lot line___.__-.. U► Number of pit s------L-------- --._Lining material :--- -----.- ize: Diameter----------3---------..Depth---- S------------------• m Cessp ol: Distance from nearest well_________________Distance from foundation.--------._._�_____ Lining material___--.-------------------------------- Cesspool: _-________-______._______ ____. p - - __ els. 171 Size: Diameter-------------------------- ----------Depth----------------------------------------------;-----Liquid Capacity-------------------- 9 T Privy: Distance from nearest well-------------------------------------------- {Distance from nearest building__---____.._-.---------------.----------- ❑ --------- ----------------------- ------------------------------------------------ Distance to heaves# lot line___�____._-:________________________ � # -------------------- Remo�d`e�li�ng and/or repairing (describe)_____ ____________________ --✓�'^---- --•------------------------------------------------------------------------ ----------------------•---•----- 4-« ----------- ---- -- -------- s - ----------------------'------------------------------------------•-----------------------`--------------------------'---------------------;------------------------...._-•-_..------------------------ I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquity n Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -------- ---(Owner an Contractor) (Signed .)- --------- •- -•-----•---• - {Title)-- -----•---- - -- By:--------------------------------------------------------------------------------------------------------------------- (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------------ ------- ----------- --------------------------------------- DATE �- DATE--------- �-------------- ---------------------------- REVIEWED BY------------------------------- -----------..- DATE. _ ------------- BUILDING PERMIT ISSUED-------------------------- ------- ------ Alterations and/or recommendations--------------- -----—---------------- -------- ••---• ....�-�� --------------- i --- -- __lf-- ------------------- --------- -------------- _____ 'r ° ----- -------------- ----------- ---------- ------------- ---- FINAL INSPECTION BY_____�__.----------------- ----------------•--- Date...,!-4'~--.a -----•---------------•-----------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Eodi, California Manteca, California Tracy, California Stockton, California 1 4 ES-9-2M 195446 ATWOOD 12-- -