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APPLICATION FOR SANITATION PERMIT Permit Na ---`7...._: ".�... (Complete in Duplicate) 5 ?/Z Date Issued ___________ ________"- I' 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. k JOB ADDRESS AND LOCATION -------- ------------49 Owner's Name. ti- ,a -----------D--------= ZO_6_ ee- ----------- - _------------------------------------ Phone----•------------------"--.--------- Address_...--- . _ lt_.� �`?'. 1 / arm �' - ---•--•-----------------------------•-•----------------------------------------•----•-----...-----••--------------.---------------•- Contractor's Name--- • -d_A/_�/�--------------------------------------------------------------------------- Phone-&4---6--g,d4d__ Installation .will serve: Residence 0, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /____ Number of bedrooms .-X_ Number of baths _,1___ Lot size ........ ........ __________________ Water Supply: Public system lam. Community system ❑ Private ❑ Depth to Water Table��_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pj�, Hardpan ❑ Previous Application Made: Yes ❑ No gL. New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: rl (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weIL_/_V,12z"istance fr m foundation----41�-------Material__6_0: yl -_____________ No. of compartments____-------------Size_.,;:; K1--t6----Liquid depth----,?a _--------------Capacity-----_r,�Ct-�2----- #Disposal Field: Distance from nearest well.1ve.. e"Distance from foundation___.}__. Distance to nearest lot Number of lines--------- ----_"`"Length of each line-------S_C3------------Width of trench____ -_____________ Type of filter material ____SR"Depth of filter material___-.. -----Total' length---------Z--•_------•------------- Seepage Pit: Distance to nearest well___A.1,1X7G- r , .�- Distance to nearest lot line_____„�f-- _ Distance from foundation___ __ __. __. ______. Number of its z �.............Depth...�_47_e---------------- p --_'_______Lining materia - r e: Diameter_ Cesspool: Distance from nearest-ivelL_._"__'_'1_Distance from foundation_______________---__Lining material___.__-_____-______.________________- ❑ Size: Diameter-------- -------------------------- -Depth---------------------------- ----------------------Liquid Capacity------•--------------------gals. Cr\ Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building------------------------------:------------ \ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe] _ d,_.'�`�s ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ----------------------------------------•------••------------ --------------------•-•-•-----------------------------------------------------•--------------------------•--------------- - 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. Signe R R-1`�' ---- �'��''--------------------------------------- ------------------------------------ ----{O .ner and/or Contractor) IBy:.... Jz----- . = ------------------------- (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------------ X- --------------"------------------------------------ DATE------ -----•--------- ----=----------------------- REVIEWED BY--------------------------------------------- 7"N - DATE L... BUILDING PERMIT ISSUED---------------------------- -- �'- -------------------- DATE U - - Alterations and/or recommendations:--- ---------- -- ---- - ----------------------•----------------•---------- ---------•---------------- ---_. ------------ = ------ ------ ---- ] _ •-• ------------------------------------------------- - ---------- --------•-------------- ----------- -- ---------•---------------- - ---- ---------------------------------------------•--------------------7---------------------------- FINAL INSPECTION BY:._z ------------------------------- Date-- ------------- -------5---- --------------------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Straot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I E5--9-2M 145446 ATWOOD 12.54 k