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V i. � � SPPLICATION-FOR SANITATION OWT Permit �No. .....,�_______o_____.. (Complete in Duplicate) 5 Date Issued __.__ I�3__l S Applica*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 O dinance No. 549. JOB ADDRESS AND LOCATION ---- - - Owner's Name------------------------_._W._.. .. --------------''-- ----_____----------------...---------------•----•-----•----•--------•--- Phone.----•-•-------•---------•-•-------• Address_------------------ - /-•--- ----•---------- ---- - - ------------------ p-��---_-------- / -- ----- Contractor's Name___________ _�_�__ �_ _ % _----__ -- Pho _�1_t� Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court ❑ MotelOther ❑ �a ��a_ Number of living units:__ __ _ ______ tuber of bedrooms _ Number of baths,____ Lot size _______ _________________ ______ _____ Water Supply: Public system Community system'❑ Private ❑ Depth to Water Table 1�6_ft_ - Character of soil to a depth of 3 feet: Sand Gravel Sand Lo��o la Loam Clay Adobe and an P � ❑ Y Y ❑ Y ❑ P ❑ Previous Application Made: Yes ❑ No New Construction: Yes - 4% TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k- Distance from nearest we11s4��Distance_from' foundation__J✓J�...Mate�al__`--! __________________l&:- _ __�____.______ �. ❑�/ No. of compartments__- _ ---------------- 'ze__c�__�. �.. Liquid depth_.._- �____Capacity___F6_--_�� -- d.(y foundation- ------ --------- to nearest lot.line—, Disposal Fi Distance from neare t wellAy"d"A - _Distance from foundation__ ___ Number of-lines.__,--____-_ - Length of each line__ _ p_�_.:_____._.Width of french.---:71 - _ ! Type,of,flter.material. .__ _ p ,� �� g _—________-_- De Depth of filter material____ ___ __ ____Total length _ Seepage Pith Distance to near t welljl_d ____ _Distance rom foun tion`_�4?.__.-__Distance to nearest lot line_ [ +/ 1 ______Linin material_ ^_._ Size: Diameter_____��1_____.Depth--- Cesspool:. _ Distance-from nearest weI Distance froOtI66ndation--------------------Lining material - ------------- E] ` - ❑ Size: .t 1 epth__ r _ _,_____ --- _ j _____Liquid Capacity--------------- -J, _ 1 I t $ Privy-,. DIsfcm µrom nearest well-L' f __ '___ _=_Distance from nearest building_,_ ___ -, ❑ _� ---Distantnea lot•iinu-"------- — _ ------ - Remodeling and/or,rep airing (descnlie):._._ I-hereby certify that-F have-prepared this application-and-+haib-the-work will one in accordance with•Sart:loaqu County; ordinances,.State law'- and-.rules and re ations of he Sart Joa n Local'Health istr' i . an (Signed)' — - —a- - - - d/' actor ntr I r location;of system in relation to well- buildm s et can be laced on reverse side sy. ___ i- - _ - G � - (rile) _ N (Plot Ian size of Iota l c y _ .. s. 9 . c-• P eT F.`_ i FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________________________ _ ' i _-- -__-- -------__-_-- --------___________ DATE_-_-s�""��__._.___;��_ REVIEWED BY------- ------•----•-------•----- - -------•••-•-------------------------------------- DATE-------__`1 T BUILDING PERMIT ISSUED -- - ----- Alterations ----- ---: _. —._ _ _ --__. DATE---.:.�.- ---- Alterations.and/o eco mendattons ___.. __.____.____ t _-_._—_—_---- �► ;� ------------ ------ ... ------•---------------------•---------------------------•------------------------------------------------------••-----------------------------------_-_---------------------_.----•------- - .,s------------------------- �-�F-•- ----------------------- SAN __---__--_'-__ - --- FINAL INSPECTION BY:.... .. .-. _______________ Date_.___._-_.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Sheet Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M 145446 ATWOOD 12.54 ,