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APPLICATION FOR SANITATION PERMIT Permit No. ...77._7..�._(..:._ (Complete in Duplicate) Io 5 j 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 4LC TION--Y_.. 5_ -._.-.- _. ------ Owner's Name A� f------ = .?—� .�3Ea. . ---- -------------------- ---- Phone------------------------------------ Address1�s-4'�= .------ Contractor's Name LV._. L�1-i------ ,:----- Phone. ._f '".?4K47 Installation will serve: Residence [0"-Apartment House ] Commercial ❑, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._.- Number of bedrooms ---- Number of baths ../. Lot size -------- ..................... Water Supply: Public'system ❑ Community system ❑ Private ®''Depth to Water Table s ft: Character of soil to a depth of 3 fee+: Sand E] ' Gravel ❑. .Sandy Loam ❑ Clay Loam El Clay ❑ Adobe©''Hardpan ❑ a Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 Septic Tank: Distance from nearest well-----------------Distance from foundation---_-'-------------Material._._........._.-....__----._-_------...._..__--_ 4 No. of.com artments_------------------------Size....__-----.__--_---_.._........Liquid depth---------------- ___-_Capacity Disposa[ Field: Distance from nearest well.... .-.-.Distance from foundation..-+3�_-.....Distance to nearest lot line_-..------------- -------------------------- Number Q...._ Number of lines-------------/---------------,-_Length of each line..-_.�"- F-...Width of trench.--_.__ .. �`.-,____-._-. �1 Af Type'or filter material-s.__ &_tJ�-Depth of filter material-------`o`_._-.-_Total length.-._.-.eF`t4 --------------------- Seepage ..__............. Seepage Pit: Distance to nearest well-_----..._x.._.--....Distance from foundation..............:.....Distance to nearest lot line+_-._-....._---. ❑ Number of pits-------------- -----_Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-..----_-_----------------____-. Size: Diameter----------------`-------------------.De th---------------------- ---------._Li Liquid Capacity ❑ P �------------- - - 9 ------------------------------gals. Privy: Distance from nearest well---,----------------------------------------------Distance from nearest building--------_..------_...___...__------_----- ❑ - Distance to-nearest lot line----------=-•---'---------------------------`--•------•---•--.:.------- ' - E Remodeling and/or repairing (describe):--------- ------ ' F ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- --------------------------------------------------------------------------------------------•-------------•-------------------:---------••--•---_------------•--------------------------------- - I hereby certify that 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. • s (Signed) �-------' -_ ----Owner and/or Contractor By:................. ....... /; el '------------------------------------------------------(Ti+le}--••------------------------------------------------------- --- (Plot plan, showing size of lot, location of (Yrs+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION--ACCEPTED BY. . --- - --.--------- .---- -- -------•---- --.......-. - -- --------------------------- DATE- -�-~------------------ REVIEWED BY---------------------------- _ _ DATE- - BUILDING PERMIT ISSUED------------ - DATE-----�------------------------------- Alterations and/or recommendations:-------------- -- -------------'-------------------------......•--.....----------------------- -•------45---- -----------..7.:----------- ff y' t .. --------. ...........---------------------------------------------------------------------------------------:............................................... ..... ��. FINAL INSPECTIONBY:------- - -------------. 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 E5-9-2M, 145146 ATWOOD 12-S4