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1 - APPLICATION FQR SANITATION PERMIT Permit No. f 42� 0 (Complete in Duplicate) ` Date Issued P ?�A , lica?-ion is hereby made to the San Joaquin Local Health District fora permit to construct and install •I This application is made ,n compliance with County Ordinance No. 549, p s all the work herein described. JOB ADDRESS AND LOCATION.. l Y ' A+ _ _I _.. Owner's Name-----------•�EL`�Jgss� ------ -�}-4S_0N----- --------------- Phone%dQ= r Address-----------------------aGs. _1------1M.'----dA,4!__FQVQN/1----------A-e-------•--••-•-•------------------------------- I' ---------- ------=----_------------ - -------- - Contractor's Name..._____ Al �,$ t- rf Phone Installation will serve: Residence ❑ Apartment House II� Commercial ❑ Trailer Court ❑ Motel ❑ Other II Number of living nits: _-9___ Number by ❑draoms -- - _ 1.-- Number of baths - ___ Lot size . .�C k_4c-____-_------_-:h-----•_ Water Supply: Publics stem K Communitysystem Private ❑ Depth to Wafer Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑I� Sandy Loam F] Clay Loam ❑^Clay E] Adobe Hardpan E] y Previous Application Made: Yes Ll No New Construction: Yes ❑ No ! 'TYP.E,.OF INSTALLATION AND SPECIFICATIONS: (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: r� Distance from.nearest well----------- ______Distance from foundation__________--_-__-_.Material ________-___-_._________ ,•. ❑9 Srlo No. of compartments-------------------- ---Sizer------------------- Liquid depth Capacity--- ------------------ Disposal Field: Distance from nearest we!i------------------Distance from foundation--------------------Distance to nearest lot linie.______..______ h Number of lines----------------------------------Length of ea El kIS TI ch.,li-ne------------ -----------• ._Width of french -' ------------ Type of filter material_________________________Depth of filter materia------------ ------ length-----------------------I_ ? Seepage Pit: Distance f nearest rest well- o/44------Distlanc from foundation--2,T________-Distance to nearest lot19 Number p " _ L_ .Linin mate ria l / _ -----Size: Diameter'j 7 peptn_., - ---_ ------ Cesspool: Distance from nearest well-------- Disfi ante from foundation______________:-__.Lining material___-_----.-_____-1____-__-____•_--_ � ------De th------ ------------------- ❑ Size: Diameter---- - ----------------- Liquid Capacity '----------gals. (� I Privy: Distance from nearest we!1=_----------------- 1.------------- __Distance from nearest building !!---� ' ❑ g �1 Distance to nearest"I`ot"line- li_ ---- - --- ---------------- Remodeling and/or repairing (describe):____ --/ __________________ _ ----------------------------------- ----------------- ---------- �'---------------•-- ` --- r 1 /_/ --------•------- -- �- - -•-•--- ----•-•- -- c-------------•------•-••----••-•---------- •----- ----••-------- - - ---------------------------------------------------------------E1 I hereby certify�that-l-h-ve prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, State la s, and r and regulations of the San'M oaquin Local Health District, q i� r (Signed) t� --- --- ...... # l!' � -. I w. ! ,Owner and/or Contractor) .. By: - '� � :.� --..Title (Plot pian, showing size a lot, location of system 1n relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY ,i I P ---- -----------.----- - --------------- •---- DATE----- ------------------- APPLICATION ACCEPTED BY_________________________ _ _ REVIEWED BY . . _ DATE.... ------------- ---- BUILDING PERMIT ISSUED------------------------ 4 s ,, i ----------------------------------- ------- DATE-------------- I Alterations and/or recommendations:_________--_____. -,----'il ------ ---------------------—-------------------------- r t a --------------_._______---_-----------_-______---__-____-_--___-___-_--_-___---_ _4- I-------------------- _.----------------.-_ ____________________ ____ Vit. ------ - ---------------------- JFINAL INSPECTION 8Y:_ �''"%�� "'��•---- Date......... SAN JOAQUIN LOCAL HEALTH DISTRICT I` 130 South American Street 300 West Oak Street I 132 Sycamore Sfreet 814 North "C" Strlaet Stockton, California Lodi, California Manteca, California Tracy, California { II -ES-9 145446 ATWOOD ` I