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APPLICATION FOR SANITATION PERMIT Permit No. .......... (Complete in Duplicate) -Date Issued Applica-l'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 Ordinanc No. 549. 2 JOB ADDRESS ANQOCAriON-------/ ----------------------------------------------------------------------- .111 7� - - 10 Owner's Name_ --------- --------------------- - ----------------------------------------- Phone----•---------------•------------- I Address hone------------------------------------ Address ------- _Z-J' `-1 ------•----------------------------------- ----------------------- Contractor's Name------ ------ _.—--------------------- -------------------------------- Phone Installation will serve: Residen e Apartment House E] Commercial ❑ Trailer Court L] Motel ❑ Other Number of living units:: ....... Number of bedrooms Number of baths __/__ Lot size ---- Wafer Supply: Public syste Community system E] Private [] Depth to Water Table .&--4 ft. Character of soil to a depth of 3 feet: Sand C1 Gravel El Sandy Loam El Clay Loam 0 Clay [] Adobe ja, Hardpan E] Previous Application Made: Yes [-] No a- New Construction: Yes JQ_No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: -4 11. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel1__/6/A7-_4_Disfance from foundation_..- 10........Material-,----<f--_(f--- ----- ------- -- No. of c`mpartments-------�--------- S iz e -(----Liquid depth----'/,,-/,, ------------Capacity--:--q------------ ' - Disposal Field- Distance from nearest well.,Ai4?7!ADistance from foundation....e<Z10__ Distance to nearest lot line--- Number of lines----------I Length of each line______ of french ------s;2 Ifer material ----- -p-Depfh of filter materi - -- --------- Ty; a I .........Total length-------- 25. -------------------- pe of fuer Seepage Pit; Distance to nearest well ----A/07�-�istance from foundation----1114.......Distance,fo nearest lot_1.ine__.__,line....�d-----. !s 81f pits-------/-------------Lining material_C�_ _ e: Diameter---- -------Depth_.--. _!�_?_e----- --------- Cesspool: Distance from nearest well-----------------Distance from foundation----------_--------Lining material-------------------------------------- ❑ Size: Diameter------------- ---- - - -----_-------Depth----------------------------------------------------Liquid Capacity----------------------------gal- Privy: Distance from nearest well.................................._._.-__.-.....Distance from nearest building------------------------------------- ---- . -1 LI F Distance to nearest lot line--------------------------------------------------------- 1� Remodeling and/or repairing {describe)--------------------- ---------------------------------- ----------------------------------------- %: -------------- -------------------- ------------------------------------------------------------------------------------------------ --------------------------------------------------- -------------- ------------------------------------------------------------------------------------------------------------11------------------------------------------------------ ----------------------------I- ------------------------ ---------------------------------------------------11---------------------------------------------------------------------------------- --------------------------------------•-------------------------------- ------------- ,11� I hereby fif that I have prepared this application and that the work will be done in accordance with San Joaquin County 'y C"T.. ere y co' ' ordinances s, and rules and regulations of the San Joaquin Local Health District. (Signed)_------•- --------- ------ ---- - -- •--------------------------------------------------------(Owner and/or Contractor) ----_-----------------------(Title)------ .. ....e-------- -- ------ (Plot loft.= w By.. (Plot plan, showing size location oipsys;em in relation to '611s, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------ .... ...I.------ ------------------`"------------------------------- DATE-----/------------------ ------------------- -------------- REVIEWEDBY------------------------ ------ --------- _------- ---- --------------------------------- ----------------------.. DATE ........... - - ----- ----------------------------------------- ------------------ - 1�_. BUILDING PERMIT ISSUED---I -------------------- -------- --------------------------------------- DATE- ___ - ------- ------ _\---- -------------- and/or recommendations:---_.-.----------------- ------ C-- ------ ----------- ---------- ---------------------------------------------------- ------- 1�9 -------------------- --- -------- -- --- ------ ----------------------------------------------- -------- ---------- ------- ------3---------7 - - ----- --------------- ---------- -------------------------- ---- --------------------- - - -- ------------------------------------------------------ -----•----------------- -------------- -----------`I------------------------- ---------- --------- - -------------------------------------------- ----- ----------------------------------- --------------------------- ----------------------------------------- ---------------------------------------------------------------------- --- - - ------------------------------------------------------------------------------------------ ---------------------------------- ---------- ------ ----------------------------------------------- FINAL INSPECTION BY..-- Date.... JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Sfreet 814 Norfh "C" Sfreef S+ock+on, California Lodi, California Manteca, California Tracy, California 145446 ATWOOD 12-54