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APPLICATION FOR SANITATION PERMIT Permit No. ..763-r (Complete in Duplicate) rp �y 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- -4OCATION--- 1,6 --- � D � - ------------------------------------ - - /� �t- Owner's Name------- ......I c - --- - - - - - -------- ----- Phone--------------------------- - ------------- --- ------- Address 1f J ZZ (�'; +.z� ------------------------------------------ c Contractor's Name. ! _. - -- d------ "Y--_r—------------------------------------------------------- Phone- ,_"f Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -)----- Number of bedrooms .. - Number of baths .__f__ Lot size ------ -/------------------------------ Water Supply: Public system C. Community system ❑ Private ❑ Depth to Water Table j�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ``' Previous Application Made: Yes ❑ No I& New Construction: Yes [2f-,Uo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septicn #ante from nearest well-_,______________Distance from foundation______________.__._.Material_______....___-____________________....__--__--. ❑ "No. of compartments---------- ---------- ----Size---------------------------------Liquid depth--------------------------Capacity--------------------•-- Disposal Field: �,1 lance from nearest well....__.._--.__._Distance from foundation--------------------Distance to nearest lot line.___._._----_-_-- ❑ umber of lines----=------------------------------Length of each line------------------------------.Width of trench-------------------_--------------. Type of filter material------------------------- of filter material---_.___- -_- ---_._Total length__.-.--------__---___------_--__-_-_-__.- Seepage Pit: Distance to nearest well._.__ _ _j4F7-oA- Distance rom foundat•on_____ Dista cer,�o nearest lot line__ 4�._�_-__--- Number of pits--------- Lining material_�it�: Diameter.--_--_ _-_----Dept k- -� ------------- Cesspool. --___Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material----------- -.--------_-__---___----. ❑ Size: Diameter--------------------------------------Depth----------------------------------- ----------- ---Liquid Capacity---------------------------- Privy: Distance from nearest well-.....................______--___.._.--.___.-_-.-Distance from nearest building.--__-..---------------_ ❑ Distance to nearest lot line---------................ Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------------------------• ------------------- _..�, -----------------------------------------------------------------•I-------------------------------------------------------------------------------•---------- ---------------------------------------------------------------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -----------•------------------------------------------ I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, nd rules a�n j�regulations of the San Joaquin Local Health District. f. �. 1-.. C -�"� [Signe _______ ------- ------------ ----- _.---------------------------------------------- ----(2per and/or Contractor) - - - BY:-------- �"�' ^ -------- --- ----- - --- -- -- - -----------------{Title) --------------- ---- (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY REVIEWED BY------- ------ ----------------- ------------------------------------------ DATE--- - - APPLICATION ACCEPTED BY-------------------------------- --- - ---.-••---------------------- BUILDING PERMIT ISSUED-------------------------------------- - - DATE--- Alterations and/or recommendations:---------------- --------------------------••------------- - ..----Q_- - ---------------h------ ---------- ---------------------- ------- - S---------- 61---t ---------------------------... '�' ---------------------------------I----------- ----- ------------- ---------------------------------------------------------------------• FINAL INSPECTION BY------------- Date- - ".l 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street S+ock+on, California Lodi, California Manteca, California Tracy, California cn-9-2M 14s446 ATWOOD 12-5a