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APPLICATION FOR SANITATION PERMIT Permit No. _3_2_0 _.-7___2 a__y__... (Complete in Duplicate) i�— 2 Z-S b Date Issued ----------------------- Applicakion is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein described. f This application is made in compliance with County Ordinance-No. 549. Dj / �Z (o 11) JOB ADDRESS AND OC TION---/ ----fz _-�. --- - ------- ,:-_ ----- Owners Name--l��- ""�-------- ?�7 ------------- Phone Address_........... s ------------------ --- ---------------------------------------------------------------------- Contractor's Name � �L .�.IQ "r ' --- Phone----------------------------------- Contractor's will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1--- Number of bedrooms _ __ Number of baths ---1-- Lot size ----- _____--_____..__-____._.___ s Water Supply: Public system ❑ Community system ❑ Private &-- epfh to Water Table r� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ,®-11ew Construction: Yes o ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ✓_Distance,)from foundation____1 ..___ _ .Materiai_- t _ _ .___._.- No, of compartments----A.................Size_, (f__x_ _ __--_-Liquid depth ----------Capacity_--.?�Y?--- Disposal Field: Distance from nearest well._�1 'Distance from foundation___;,_ ......Distance to nearest lot line. /2�----_ y Number of lines------/................ Length of each line___-,, 11____...____._.Width of french_____ j& Type of filter material/.—__ ._.Depth of filter material----!,__.-------- otal length_--,____-------_------------------- Seepage ________ ___ __Seepage Pit: Distance to nearest well- _.K" ._Distance from foun �ation---� --------Distance to nearest lot line_._f!.---------- Number of pits._._.__`_._..______Lining material6_ Size: Diameter,�UEr___.____Depth_--_-�- --___.-_____- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter------------------- -- ------ -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ________________________------------------------Distance from nearest building-----.______.___________________._______- ❑ Distance to nearest lot line-----------------------------•------------------------- --------------------------------------------------------- --- --- ------ I Remodeling and/or repairing (describe}-- ----------- /Lle4l�`1----- . -----------• ------------------------ e i ------ -----------------------------------...---------------.------------------------------- ---------------------------•------------------------•4---•---•---------------------------- _.. . 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 Joaqu' local Health District. ------------ -----•-- r ontractor 4�1 01 (Signed).. ' ,,/ BY: 'L /2,fir'` `� (Tifle) - L/'-- (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----------------- --- ------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ----- -------------•------------------------------------------- DATE------------- --� - - Alterations and/or recommendations------------------ --- -----------------------------.-.-.-_--------------------------- w, r ------------------------------------------------------- ------------- ----------------- -- --------------------- ------------ ------- ---------------------------------------.. ._tif. _.. ---------- --------------------------------------------------------------------------------------- ----- --------- T ---------- -------- -- ------------ ------- - -------------------------------------------------------------------------- -- ------------------------ ----------------------------------------- -----. •-------------------------------------------------------------------------------------------------------- _ FINALINSPECTION BY:."--- ---- ------------------------------------ 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 ES-9-2M 145446 ATWOOD 12-54