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- � ° ) / in APPLICATION FOR SANITATION PERMIT Permit No. -------------- (Complete (Complete in Duplicate Date Issued .__. ___7e_. 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 Coun Or No. 549. -JOB ADDRESS A LOCATION ---- . -- ----- /'nance '�='�''�.e� ------ ----- --------------------------------- --------------•---------------• 19 Name " ..� 1- [' _ ---------------------------------------------------- Owner's Phone - ---------------------- -- %��-- '�--------- ------ Phone Contractor s Name_._ Installation will serve: Residence "'/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ --__ Number of bedrooms _ -- Number of baths _f- .Lot size ._f d a_.-. ---t.X-q-------------------- Water Supply: Public system ❑' Community system<❑—Private &-6epth to Water Tabt...........,,,. ,..:� -^• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑Clay❑d Adobe ardpan ❑ o lNew Construction: Yes ❑ Previous Application Made: Yes El1o �-�`� TYPE OF INSTALLATION AND SPECIFICATIONS; _ (No septic tank or cesspool permitted if public sewer is available within 20o feet. �� a Septic Tank: Distance from nearest well___ . -_-__--Distance from/foundation----- // i �— No. of compartments ;?--------------Size--.r4---/�--��--�-Liquid depth----�.�----------Capacity---O-G'� ---- Disposal Field: Distance from nearest well--- Distance from foundafian____!a__F_----Distance to nearest lot line__/d_�__. �. Number of lines-------_-�__.__ / Length of each line.-- -_-7)_l -,.-.Width of trench---. _f_________________ Type of filter material---------i------------.-Depth of filter material.___. _Y__.7ofal length________��____________________`__-_ o ` /6C Distanceom fou�dation__�_ ...�--.Distance fo nearest lot line_.,_-___.__._. + Seepage Pit: Distance to neares#well_._. ___._.--..- _._ ,� Number of pits--!.--" ---------- --Lining material___I,;��_ _.Size: Diameter___. __0'_..____Depth------- — __r__________-- Cesspool: Distance from nearest well_________.._____Distance,from foundation...._,_..... Lining material--------------________________________ Size: Diameter.-----------------. _.. --"'Depth__--- --------------- Liquid Capacity gals. ❑ I -------------------- r Privy: Distance from nearest well------------------------------------- -----------Distance from nearest building----.--.----------------------------.----- \4 ❑ 'Distance to nearest1ot line.----------------------- f--------------------------------------------•--------------------------------------- 4 Remodeling and/or repairing (describe):--------1----------------------------- ------•--------------------------- -•---------••----:-----------•-----------•--------------------------------------- # s .................................... ------------------------------------------------------------------------- ----------------------------------------------------------------------- I hereby certify that I have prepared.this application.and that-tine work wi l'lie"done hi•accofdance wit} San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. �,y� ---------------------------- --- ---------- r Contractor .sa�v " (Signed).;- ----------------------------- �Y= _ •--------------•-•------------------(Title (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 ` - --------•---------------------- -------------------------------------- REVIEWEDBY------------------------- ------------------------ --- _ DATE-- ------- -- ------------ BUILDING PERMIT ISSUED------------------- ----------- DATE Alterations and/or recommendations:------------------ -- ------ -------------------••------------------------------- •----•------------ ---- f --------••-------•--•---------------------------------------------- -•----------------------------JI-------------- --------------------------- ---------------------------------------------- -------------------•------------------------ --------.-.•------ --- --------------- FINAL INSPECTION BY:-------GAJ ------= _ ----------•---------------- Date__. .__ ._ V._T-------------__ ____________________..___ SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street r 130 South American Street 300 West Oak Street 132 5 Y Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 145446 ATWOOD 13-s4