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i APPLICATION FORSANITATION PERMIT P P Permit No. 7t I!: {Com Tete in Du licate /�v II a �v Data Issued __-.l-_ _L.-__ 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. 7 :. JOB ADDRESS AND ---- -- —N ------------ ------------------------ ------- --------------------------------------------- ------ Owners Name -- -----••-•--------------- - -- - ---- -------------------------------- Phone------------------------------------ Address-................... , R------------- Contractor's Name---------- L.c �'� f.__ __ _ 1 Installation will serve: ResidenceApa" n nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: Number of bedrooms ___ Number of baths J.__ Lot size -------------------- _____________________� Water Supply: Public system Community system ❑ Private ❑ Depth to Water—Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ AdobHardpan ❑ Previous Application Made: Yes ❑ No�<_�ew Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '� " Septic aokse tic taDistancersfrool.permitted if public sewer is available within 200 feet.) � P cesspool. � � nearest well_��_ _____--Distance from foundation_ o----_--___.Marterial-___C.01��.0 ,a _-.-_____- No. of compartments_... .______----------_Size___ -_ _,K_ _._.-Liquid de th_---------_._._ p. -------Capacity----2-�°�---- I sr .-r Disposal Field: Distance from (nearest well'��__.__Distance from foundation-_:Lo..........Distance to-nearest lot line___s ------- Number of lines_____ __ _ -__--__-_ gth of each line___._&_.d------ Width of trench___. ________________ Type of filter imateria filter material__�_F_.._____Total length___..._Z----Q_�_________----------- Seepage ________ p g I See a e Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-____-.-__-._-__. ❑ Number of pit`s----------------------Lining material----------------------:Size: Diameter------.----------------Depth-----.,-------------------------- Cesspool: Distance from nearest weld-------'-____-_Distance from foundation-------------_____.Lining material...__-________________________-__. El Size: Diameter--- i. ------Depth--------------------- --------_---Liquid Capacity ---gals. Privy: Distance from'�nearest well-------- ------------------Distance from nearest building_____________________________________.._. Distance to narest lot line- - - 4 Remo a in- a or repairing describe : _ -____-__ i 'i ----------------- ----------------• ---- - --- --------- -------- ---------- ---- ---- ------- ---------------------------------•--- -- �" ------------------------------------------------------------------------------------------------------ ----------------------------------- I IN I hereby, certify tha I have prepared this application and that the work will:be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----• w - .1 1t�.• ", ---------- -------- -- --------- ---------------- - ----- ------{Owner and/or Contractor) By: ------- �`'- f t ---` s=-�-=_,:�_AWW--------------- --- ---------------- Title---------------------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------- ------- - -------------- DATE------�------ REVIEWEDBY------------- ----------- ------------------------------------------------------- DATE-----------* - BUILDING PERMIT ISSUED------- '---------------- --- ---- ---------------------------------------------------- DATE------------- -----d•--_---- ----------------- Alterations and/or recommendations:. = ----------------- --•- -----•---------- ------------------•------------------------------•---------- ----------------------------------------------------------------------------------------------•--------•---------------------- ----------------- 8 ---------------------------------------------------------- -------------------- _---------------------------------------_________________________________----------------------------------------------------_---------------- / r FINAL INSPECTION BY:... -------------------------------------- Date------G----'= ---- --------st------- ••------------------- - h` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street II 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California !f Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD