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� APPLICATION FOR SANITATION PERMIT Permit No. —7./._qI 0 [Complete in Duplicate] Date Issued ---Ux b 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 madein compliance with County Ordinarx No. 5 9. nr JOB ADDRESS A`� LOCATION __— --- �9T .- Owner's Na a--- •-------------- - - ••------•------- i - ------------------ ---- --•---=--•------------- - -------- - - Phone:---------- /� ------ --------------- Address_ �-V----'.0---•-------`--•- 6L_ Contractor's Name------6'11- -----------------------------------•---------- ---•--- ._. Phone-------------- Installation will serve: Residence ®fApartment House ❑ Commercial ❑ Trailer Court ❑ Motelr ❑ rOther ❑ Number of living units: Number of bedrooms ."7"-- f Number,o baths Z- Lot size J_1/1ii Q I Water Supply: Public system ❑ Community system ❑ PrivateDepth f Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [j] New Construction, Yes Ff No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ F Septic Tank: Distance from nearest well_________________Distance from foundation__._________.-. .._________-_._________._. 'frl-r�� No. of compartments------------- - ----------Size_'�r!--=-------------• -----Liquid de th------ . ----Capacity l Dispos Feel • Distance from nearest well --_--Distance"from founda#ion__________._ Distance to nearest lot Gne 'N jf/ Number of lines___________ -.--- f_________/Length of each line---------I .t�_� "---.Width of trench.-------.- --�'______ Type of filter material__ . •1 p m 1 l7e th of filter material------_-�- - -----Total length Pit: Distance to nearest well_____-_.____.........Distance from foundation--------------------Distance to nearest lot line_._______._____. Number of pits. Luning material ----------- Size: Diameter--------------r--------Depth---------------------------- Cesspool: Distance from nearest weil�_---------.__Distance from foundation___________________ Lining material Size: Diameter------------------'-------------------Depth---------------------------------- -----------------Liquid Capacity-------- -------------------gals. Privy: Distance from nearest elL___________________________._ ___.___Distance from nearest building ❑ �' 9 bis#ante to nearest lot line___________________________________ Remodeling and/or repairing (describe):-------------------_---------------------------------------------- -------.---•-------•--------------------------------------------•-------------------------- --------- -----------------------•---------- -------•---•--•------------•----------- -•--------•------------------••-----------•------------------------------------------------------------------- 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-ules d regulations of the San Joaquin Local Health District. (Signed)___ ___________ ________{Owner and/or Contractor By: ------------------------------------------------ --- - Title --- ----------- - - - ----------------------- ot 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_ - I WED BY = - --------------------------------------- DATE-- BUILDINGPERMIT ISSUED-------------------------------- ----------------- ----- ----------------------------- DATE----- ----•---------- �- --------------- --------- �--------------- Alterations and/or recommendafions:----------__---------------------- --------------------••--------------------------------------------•--------•------ --------------------------------------- -----•- • - - -------- FINAL INSPECTION BY:------ - -------- ----------------- ---------- Date-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ' Lodi, California Manteca, California Tracy, California es-9-214 145446,ATWOOD 12.54 '