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APPLICATION FOR SANITATION PERMIT Permit No. (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 w' County Ordi, nanFe No549GOCATIO eXJOB ADDRESS C, K, Owner's Name----_mac.. ........ ..!. -::__ ----- - Phone �•�- Address.•................. -------•--• ...... . -- --------- -------- - Contrector's Name r ..------•--------- PhoneAk Installation will serve: Resid ce ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 171 Number of living units: ........ Number of bedrooms -------- Number of baths ---!_. Lot size ..__....___"...........................................•- Water Supply: Public system [r'fommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe4Q--Hardpan ❑ Previous Application Made: Yes M_—No ❑ New Construction: YescB- No ❑ 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/ Distanc from fo ndation._,/l?_�______.Material.. <,-___ %s! __-•;�_-- No. of compartments________ --___.__Size.....6_„7'_ !YLiquid depth------Z_.Q..........Capacity...f__- __ __-- �w.o Disposal Field: Distance from nearest welV�_ ..!7__Distance from foundation._1 ........Distance to nearest lot line---._'"---••- Number of lines..----------/.._____. _ g T .__ ____.____Len Length of each line______..__�______________Wldth of trench------,2.•4_____.__.___._.___ Type of filter materialse_<_..Depth of filter material___.- ..........Total length_______-__7.,:S7._'.................. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------_----------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------__. ❑ Size: Diameter--------------------------_ ---------Depth------------------------------------------------...Liquid Capacity----.............-.........gals. Privy: Distance from nearest well------------------------------------------------_Distance from nearest building_._____--___-___•___._----•---______-____. ❑ Distance to nearest lot line-------------- -------------•--------------•----------------••-------•----•------•------=------•---------•-••----------------------•---•---- Remod ling and/or repairing (describe) 1-A 1 ------•••. ---------- ---• --- -•---- ----- ------ ---------------• zt --------------- ---- ..........Y�----- ....... --- -------- -- - - - -- r I hereby certify that I have prepared thistalication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r ulations of the San Joaquin Local Health District. (Signed) -_--�- ------. ----- ----------- (Owner and/or Contractor) _. By:.... - (Title) . .......... ........•---•------- ------ -----.. _ ..- ----------- -------- ----- ----- - - - --------------------- (Plot plan, showing size of lot, locate of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------ --r - ----- --••----- ------------------------------------ DATE--------- - 6q - ---------- REVIEWEDBY--------------------------------------------------- - --------- -- ---------------------------------•------- DATE....•-------------• --•---•. ------ BUILDING PERMIT ISSUED.........................•--- ------------------------------------------------------- DATE•------------------------------ ---------------------------- Alterations and/or recommendations:--------------------------------------- -----------------------------------------------------------------------------------------------------\---------------- -------------------------------------------------------------------- ------------------------------------•------•------•----------••••---•--------••-------•------•--•-------•----•-•--••--•---•-•------•--••-.....----•.._.. --------------------------------------------------------- -----------------------------------------------------------------------•--------•------...----------•-----•----•--••-------•----•-•-•---------•-----•-••----------. -----•-------------------------------------------------------------------------------------------------------------------------------------------------•------------ -•-------•-•••-------•---•-----------•---•-----•-••------ ------------------------------------------------------ ------ ----- --_. ---------------------- ---------------------------------------------------- FINAL INSPECTION BY:. --------- -------0---------------------------------------------------- SAN 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