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APPOCATION FOR SANITATION PERMIT-i149Permit No. ._�__L-- - _ " y (Complete in Duplicate) ^(j Date Issued Applica-lion 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 Ordinance No. 549. + JOB ADDRESS AN OCATI 15-L/.-/1� S_ A ----- -- ------- - j........... Owner's Name---- 1 _ Address-------••------- ------------------ ----------------------- PhoneJ_.d---- - ---- ---------------------------- --- - Contractor's Name----:----_----_--•-_--_---- - • --- - -- ---- --- • --•-----•------ ----------- ----•---- ---••--------------------------------- ---- --------- ---------------- Phone-- -- -•�--�'--`��Q Installation will serve: : Residence ®Apartment House E) Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -� Number of bedrooms _ -___. Number of baths __/__ Lot size ___ ..f �4 4 afer Supply: Public system ❑ Community system ❑ Private [Depth to Water Table eft_ Character of soil to a depth of 3 feet: .Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ Previous Application Made:: Yes ❑ No (P— New Construction: Yes ❑ No [ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__,_ ,a,---_ Distance from foundation___ a + �el �f'I�/� 1 Material El " �� No. of compartments-r �.---�----•--Size_.5�---,�-�b_---_--Liquid de fhr_--- '� P �_Q ------Capacity- 94d �'] os ;eld: 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-----------------------_Total length-____________ pa Pit: Distance to nearest well_____ _____________Distance from foundation___..____.._.____!).Distance to nearest lot line__-________.-.___ Number of pits-------------- -----Lining material-----------------------Size: Diameter----------------- ----Depth-----------------•---_ esspoa : Distance from newest well_s _____Distance from foundation------------------F. Lining material -------------------- ❑ Size: Diameter---- -----------r--,----------------Depth- ----------------- ------------------Li ui.d Capacity ------ - ---- q --------•------------------gals. Privy: Distance from nearest well____---__-___'__--__ {„ --�, ----------------------------Distance from nearest building 1 Distance'to nearest lot'line.-._._._'*___.-_-_- - -- =_ g ------------------------- - Remodeling and/or repairing (describe)------------------- ----__ ---------- -------_------------------I---------------- ---------•-------•--- ------------•------•----•-- ---•----------- ------+----------------- - k i -� h _,. _ ----------------------- •-----••------------- - _ --------------------------------------------` - - I hereby certif ave prepared this application and That the work will be done in accordance wish San Joaquin County t ordinances, Sta aw , and r !es and'regula+ions of the San Joaquin Local Health District. r t (Signed) + ; ---- O ner and/or Contractor) BY: --•------------------------------ ' ----------------------- ------------------- Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY---- ------- --_-- DATE � - VIEWED BY ----------------------------------- ----- :_ s r _ DATE '� BUILDING PERMIT ISSUED--------- •-------------------------••------------ -- DATE-------- ---------------------------------- -------- Alterations and/or recommendations:___,_-_--- __ '-�.l- ---•------------------- - ------•-__--••- ----•-- --- ----------------------- ---------••--•-----•-- ------------------------------------••--------------- ---------------------------------- ------------------ ------- ------------- FINAL INSPECTION BY:--------- � _� , -- --- --------- ------------ -------- Date- -------�-.........- I-- -r--- - ------------ --------------------- $ SAN JOAQUIN LOCAL HEALTH DISTRICT El 130 South American Street 300 West Oak Street 132 Sycamore Street I Stockton, California 914 North "C Street Lodi, California Manteca, California w. Tracy, California E5-9--2M 145446 ATWOOD 12.5a