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APPLICATION FOR SANITATION PERMIT Permit No. _.__ .3 3------ ' (Complete in Duplicate) / Date issued Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDvJLOCAT ON..________ -�-A-------- -----------•------------------------•--•-------------------------.-----•------••---- Owner's Name--------- - ----------------------------------------------------- ------------- ------------ ----- Phone..--•-----------•---------------•--- Address-------------3-------- ---- ------------------- ------•----------------------------------------------•- ------------------------------------- --------_---- _::)Name--------- C�d - Phone/ _�.z_G /1� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /---_ Number of bedrooms .i;97 Number of baths _/•- Lot size ------$7A'_X/4 Water Supply: Public systemCommunity system El Private F1 Depth to Water Table _,3 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No [?"'New Construction: Yes jalNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if public sewer is available within 200 feet.) _.- -- '-----Distance from nearest well � Distance ��m foundation C'_._Septic T k: --___---Capac iNo. of compartments-----_._ _------Size _4 - --- P__ Disposal field: Distance from nearest well Distance from foundation____0-_ ___.__Distance to nearest lot -�------ ---- ------ l-in�e�------------ 21, ________— 2Number of lines-------- r Length of each line---- d---- ---- ---Width of trench.-- � -------------- - Type of filter materia ...Depth of filter material-------Z Seepage Pit: Distance to nearest well_.' ` _Distance from fours ation__.3�-'-..Distan fe to nearest lot line--___�__--. __Linin material_ __.�ize: Diameter__.._ Number of pits.-.-- -- C;C --- •�-�---- .....Depth---.-�5.----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----...............Lining material__..___..-___,______.___._____.__--.-. �? ❑ Size: Diameter-------------------------------- -----Depth------------------ ------------ - -----------------Liquid Capacity-.--------------------------gals. (A► Privy: Distance from nearest well.....!--------_-------------------_---------------Distance from nearest building---------- -----------------.--_________- ❑ Distance 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, rules and regulations of the San Joaquin Local H alth District. (Signed) -... .T- + Contractors ...�" " ----- -------- .. By:------------------------------------------------------------------------------------------------------------------------------._._.{Title) (Plot plan, showing size of to+, location of system in relation to wells, buildings, e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- . DATE------ ----------------------- ----------- REVIEWED BY--------------------------------- DATE -------------''I��---------------------------------- BUILDING PERMIT ISSUED-------------- -- - ------------------ -------- --------------- ------ DATE_ --- -- � Alterations and/or recommendations----------- ----- ---•---------------••-•----------------------------------��--------._.... ---------------------------------- -- --------------------------------------- ------------------------ -------------------------- -------------------------•------------ ---------------------------------------------- ........ --------- ------------------------------- ------;--------- -------- --------------- 'FINAL INSPECTION 'BY:-.----- ----------- ------ ------------ Date ----_S------------- ------ -------------------- ------------------------- 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