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APPLICATION FOR SANITATION PERMIT Permit No.LT D (Complete in Duplicate) S 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. JOB ADDRESS AND LOCATION._ ___7�------------- --o--------&*,ed,11v,1.+.L-----------------------------•-------------•---------------•-• •. . Owner's Name---------17-i..��--------D - Phone -- ----- -- --- ----- Address.......• l �Y j ----- ••-----••--------•-- ------------------ Contractor's Name------- ---- ,._•?---••-•- ------------------------------------------ Phone__,P A-7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "' Number of living units: __I.___ Number of bedrooms .�r__ _- Number of baths __. Lot size -_._-_G__9------Al__;k---6-_________________ Wafer Supply: 'Public system ❑ Community system ❑ Private 2;L_Depth to Water Table .4e ft. _1dharacfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No W_ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest _Distance from foi�undation__.__ ____-Materia -- .�- �,4__ �------. No. of compartments.____.___ Size__{ __ ,.�7_�____Liquid depth._.__.l-(a_ -----Capacity____e151--v____.___ Disposal Field: Distance from nearest well_________________Distance from foundation-----------------...Distance to nearest lot line-.-..--__________ ❑ Number of lines---------------- ------------Length of each line---------------------- ----...Width of french----------------------------------- Type of filter materiaL___...._ '__�_i_____Depth of filter material___-._______._.-____Total length----__ _______________________--__l Seepage Pit: Distance to nearest well____-` --_--Distance from foundation--._1A,._._._.Dista nce nearest lot line---- ,__.___. Number of pits------..............Lining material_&.(7�<e: Diameter-------_�__�__-.Depth-------�_c�__------- (V,� Cesspool: Distance from nearest well-----------------Distance from foundation..... ..............Lining material----------------- _- .__._________- ❑ Size: Diameter------ ----- -------------------------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. Privy:: Distance from nearest wel1-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest'lot line-------- -------------------- ----- -------- - -•------------------.._ ---------------------------------------------------------- --- Remodeling and/or repairing {describe):------ ---------------------------- ---------- ---I.....----------------•----------------.-•-------------------------------------.------------------ ---------------------------------------------------------------- -------------------------------------r----------- ---------------------------•--------------------------- ------------------------------•------------------------- -----•------------•----------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, and rules and regulations of the San Joaquin Local Health District. C _rr (Signed)------- ----- ---k----T` �` s-�r--v---------- --------------------------- ----------- ----(Owner and/or Contractor) By..- -- - - ---------- -- . ...._. •• •� - - ••--------•------------------(Title)..---��`------------------------------------ (Plot plan, owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICAT.lON ACCEPTED BY - DATE - { - ------------------------------------ REVIEWED BY--------------------------------------------- ---- ---- - --- - ----- - -------- --------- ----------------- - DATE------ --------�.---------------•-----•------•------- a - - -------- $UILDING PERMIT ISSUED -•---------------------- ------------------------------------------------- DATE.--------.',-: - •- - - ----•------------------•- Alterations-and/or recommendations_________________________ -- -- ------------------------------------------------------------------------- ---------------------- ------ --- -- = ==t--------r----- ---------•--------I----.------ -------------------------------------------�.................. tr - - ------- —s j--------------- -- �� `' v`, i - --- - -f- ------ -------------------------------- ------------- --------------------------- -------------------------------{-------------------------------------------------------------------------------------------------•--• ----•- --------------------------- ---------------------------- ----- ----------------------------------------------------------- -------------••--- ---- FINAL INSPECTION BY.. ------- ----------•----- ------- --••-•---------------- Date.--�-------------------------------- --------- -•------------------------ SAN 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 ES---9-2M 145446 ATWOOD 12-54