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_11� �-�\ �� x (� (tg 16 APPLICATION FOR SANITATION PERMIT Permit No. -. _TI. -_ . (Complete in Duplicate) Date Issued _____. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------�0-1.6----------- 6--0-------: -----_-------- - -------_-------- Owner's Name -�- �t d� _ ------------- ----------------------------- -:---- Phone :. Address--------- --• -------------- ........... --•--- ------- Phone-Contractor's s Name-----�!_-��:-fld��----�--.�-�i - Phone - Installation will serve: Residence 0, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f____ Number of bedrooms __Number of baths .__?_.. Lot size ____ _____________________ Water Supply: Public system Q Communify'system ❑ Private ❑ Depth to Water Table __/eft. Character of soil to a depth of 3 feet: Sand '❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: Yes ❑ No E] New Construction: Yes ❑ No Z!, r TYPE OF INSTALLATION(AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tag tto e nearest well-----------------Distance from foundation-----------------�-.Material------------------------------------------ '41o. -----..------- ----------------•-------- iYo. tompartments_____________________ ____Size__________-_._ Liquid depth__________________________Capacity--_-_._______.__-_-_--_-_•;❑ � Disposal Field: Distance from nearest well'_A/077-Distance from foundation____), y Distance to nearest lot line---_f- Number of lines________ ______ Length-of'each line____. - -_._ Width of french__._e� __a_'____-_____ Type of filter material-1--.2'____��_X Depth of filter material____-4_9_________Total length------- ---____________ ______ i�Distance from foundation____. _" rline----. '�: ` � Seepage -Pit: D-istance.tb nearest well -__ ____..Dis�an�e to nearest lot ` ©I Number of pits __.__'�___________Lining maferial-e_______�� i� Diameter-_-.. ,--- -__----Depth........ _________. LA Cesspool: Distance from nearest well_--- __._,___Distance from foundation_..____...._____..Lining material__ ______________________________. ❑ Size: Diameter --------------------------------Depth-----------------------------------------------------Liquid Capacity- -------_----------------gals. Privy: Distance from nearest well ________________. -----------------------------Distance from nearest building __________._____-_ ❑ Distance to nearest lot-line--------------------=----------------------------------------••----- =-------------•------------------------------------------------------- 3. Remodeling and/or repairing (describe):------------- }-----------------------------------•------•--_-----•-- --------•---------------------------------------------- -----------------I------------------------------------------------ --------•---_----------•-------------••-----------•--------------------------•---•-•--------------- ------- ----------- -•----------------•-------------•------------------------------------------------------------------------------------------------ ----------------------- w. i -- I I hereby ce ' hat;'I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, S to la s, and rules and regulations of the San.Joaquin Local Health District. .� (Signed ------------------- ------------------------ ----- (Owner and/or Contractor)y �J_ 1r Com- - c _ ------------------------ y. w�e of lot Iota+ion of s stem in-rel�on to wells, buildin s, etc., can7itle).___C -4 -------------- B . [ (Plot plan, s i g i y g 'be placed on reverse side). FOR DEPARTMENT USE ONLY t. APPLICATION ACCEPTED BY---------------------------••-:_--._._..-..--------- - - DATE---------_- � ��" ---------------------------------- - --------------------- REVIEWED BY-------------------------------- - ---------- ---- DATE--------------------------- - - ------------------------------------------------------------------- - BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE----------------------------------------------------------- Alterationsand/or recommendations:----------------------=---=-------------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------•-•--------------------•--------------------------•-----------•---•----------•---_----------------•---------.. . ---------•---------------------------------------------- -----------------------------------------•-- ----------------------------------------------------------•- -----•-------•----- --------------------- ---------•- ---- --------------------- ------------------------ --------------•--•--a---_-- ------------------------------------------------------ FINAL INSPECTION BY: '? Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12.54