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APPLICATION FOR SANITATION PERMIT Permit No. r (Complete in Duplicate) Date Issued __---- - .-. -�- 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 Ordinance No. 549. oy -------------------------------------------------------- JOB ADDRESS AND LOCATION.._-'_.- " --�--'"-1l--�-1�'�-- -�---- ------ ----'------ ------- Rhone--- ----------------••------------'- � Owner's Name------------- ---- ------- ------=• Address--------- --- --- ---- ------------- Contractor's Namur l ----•---------------------------•--. one Installation will serve: Residence,! Apartment House El Commercial C] Trailer Court ❑ Motel ❑ Other Cl Number of bedrooms __ Number of baths - - - Lot size -----�_o----------.Z'-�--�,6--------------------- Number of living units: { Water Supply: Public system $a_ Community system El Private E] Depth to Water„Table - ft. ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay,❑ Adobe Hardpan ❑ Previous Application Made: Yes'❑ No .. New Construction: Yes ❑ No P�L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r l Material -------------- O- -- e Septic Tank: Distance from nearest well-- from fo�r�dation.- Capacity ��-b- rY1 No. of compartments-----------/Vmuoistance ------ - -Size----------1 ----'-------Liquid depth-------<R'-�'-'-- '- p t lin ' Yom- . r ---_.Distance to nearest lot line------ --—---- Disposal Field: Distance from nearest welV..�at�istance from foundation---. f Number of lines----------1...........t'--------Length of each line-------a�-C ------Er- Width of trench-------- --------------- Type of.filter material---f•_ _ - -S-Depth of.filter material----.-. 1_-------Total length---------:,-,ZD---------------------� stance from four�dation_---� - Z-f-.Distance to nearest lot Seepage Pit: Distance to nearest well^l�`7 .C.iD Diameter--.., `y--Depth_.--', l '- - - q �- Number of pits_.-.._-�-----.----.-Lining material _._ Cesspool: Distance from nearest well-------------- Distance from foundation.-._-.- Lining material----_-.-.-----.-- .--._.--.---.--_-.. ---..-L's Liquid Capacity gals. ❑ q P y--------------------------- Size: Diameter--------------- -- Death Privy:' Distance from°�earest well---.-.---'----------------- - Distance from nearest building------------------------------------------ ❑ � Distance to nearest lot line--_.-_.-_..-�------------ -- -------------------------------- --------------------- F R�eAmo�eling yd/or r airing (desgibe):_ w --------��•---- U Z-.----- lGt �------ L'"ti?10 ---------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaquin County ordinances, State ws, nd rules and regulations of the San Joaquin Local Health District. r and/or Contractor) - e d/o or) ' Si ned - _ _ _ - [Title]----- -- ----- -----•----'----- By- - I buildings, etc., can be placed on reverse side]. (Plot plan, showing size'of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- - ---------_---- ----------------------------- DATE----------1.�-----''- ----- - ---- DATE----------------------------- ••--------- --- REVIEWED BY-------------------------------- --------------------- --------------------------------- -- --------- -----'-- DATE-- -- --------- -- ------'----'------'--'--••---------•- BUILDINGPERMIT ISSUED.---------•---------_---------------------------- --------------------- ----- Alterations and/or recommendations:-- ------------------------'-- 1 [ � _. -.-. ,f •-- --- --------------••------- ��y ----••- ----- ----'--- --'-'•'�-�- v.r ja --- -- --`---- --- ------ ----------•--------------------------------------------- FINAL INSPECTION BY: ---- Date--- -=- '- -------'--- -------'-- '--------� ---------'---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac , California Stockton, California Lodi, California Manteca, California Y rS_J-2M 145446 ATWOOD 12-54 F