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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 Ordinance No. S49 ..d -d— JOB ADDRESS AN LOC TION_..... - ---------------------------------------------- SS AN LOC TION_ ------------------- Phonj_S7�4-71_q------- Owner's Name--/--------------- -- --Address--------- - --------------- ------------ -- ------------------------- -------•----------------------------------•------------------------------ ---- --- ------------------ Phone 's Name Contractor's Name- Installation will serve: Residence artment House E] Commercial E] Trailer Court 0 Motel [E3] 'her ❑ Number of living units: Number of bedrooms vof baths _/--- Lot size ---- x---//- ----------- Water Supply: Public system �nify system El Private El Depth to Water TableAiif-Oi7T. Character of soil to a depth of 3 feet: Sand [j Gravel E] Sandy Loam El Clay Loam 0 Clay E] Adobe lvdp-670— Previous Application Made- Yes E] No@4��ew7onsfruction. Yes [-] No TYPE OF INSTALLATION AND SPECIFICATIONS-. (No septic tank or cesspool pe'rmiffed if public sewer is available within 200 feet.) Sep iC dank r Distance from nearest well-_,_._-----._.--Distance from foundation--------------------Material----------------------------------- -------- No. of compartments---------- - - -----------Size--------------------------------Liquid depth.------------------------Capacity----------------------- I Disp epth----------------- --------Capacity----------------------- Disp Sal F5,11. Distance from nearest well- Distance from foundation----------- ........Distance to nearest lot line---------%7" Number of lines--------------------------------Length of each line------------------------------Width of trench--------------------- --- ------ Type of filter material--------- -- ---------- ---Depfk of filter material------------------r---Total length____..-_----_------_----_-__-_-.----.---- r Seepage Pit: Distance to nearest well&1,7g�o_�. ----Distance mfougdation---/,Z----'_Distance to neare / 0 , b6ao-- Number of pits.--------14'_ -------Lining m Size: Diamefer-3T_1----------Depth Cesspool: Distance from nearest well-----------------Distance from foundation--- -------------Lining material_-.._------_-_------- - �55 F-1 Size: Diameter---'----------------------------------Depth--------------------------------------------------Liquid Capacity---------- ---------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------_--------------.--_-_--. ❑ Distance to nearest est lof line-- ----------------- ----- - - ---------------------------------------- ------------------------------------------------------------ Remodelingand/or repairing (clescribe):-.------------------------------------------------------------------------------------------_- -------------------------------------------------------- ----------------I-------------------------------------------I ------------------------------------------------------------------------ -------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------ - --------------------- -------------- ------- ------------------------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin-County ordinances. St ws, ndjes and r gu lations of the San Joaquin Local Health District. - --------------------- -----few"&�Or_Confractorj (Signed)---- -- -- ----------- - ---- -----------I-- ---- --- 111A, By:------ --- 0t ----------- -----(Tif le)--------------------------------------------------------------- -- ------------ -------I---------------- ......... ----- uo� (Plot plan, s owing size a lo+'. Ioc`a"i`ioh of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By DATE ---------------------------- ---- Q------------------- --------------------------- REVIEWED BY------------------------------- DATE----- BUILDING PERMIT ISSUED------------- U. ------ DATE. ............ - _�7i.,----- -------------------------------------------------------- - Alterations and/or fcommendations:----- _d_ ------------ ---------------------------------------------------------------------------- --- r - ------------------------ ----------- - --- ---- ------------------------ - ------------------I------- -- ----------------*----------------------------------------------------------------------- -----------11-1----------- ........ . ---------- - - ----- -------------------------------------------------------- ----------------------------------------------------- --------------------- ----- -- - ----------- ... ------- --- ----- --------------------------------------------- ------------------------------------ --- ---------------------------- ----------- ------ --------- ------- ----------------- ------------------- -------------------------- ---------------- ------------------------------------- _------------------------------------------------------------------------------------------ e_�s 1.� Date-I.C.-__�A1--sZ-—-------------------------------- FINALINSPECTION BY..,---- ------------------- ----------------------- ------------ Date-- JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWOUD 12.54