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1\ 74 / APPLICATION FOR SANITATION PERMIT Permit No. ...,�Q, �e.-._... (Complete in Duplicate) �� Date Issued IV 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. S49. JOB ADDRESS AND 4C1.ON..__ _2____[s.1�'7%� _ �d.._.....^ �- /P/��-VOwners Name ...... .••----. - - ----------------------------------------------------•------ PineAddress---------••---•.......•. _.. 4 4Contractor's Name____.. _ ________________G�:%?�(/} . ` ' � -------------------------------------- Phone.,l/-'rt Installation will serve: Residence (R-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _Other ❑ Number of living units: _ __.. Number of bedrooms __; . Number of baths .1..... Lot size ----. ',G�Pl1�C-tt ,----•------------------ 1 Water Supply: Public system ❑ Community system ❑ Private a-6epth to Water Table .ii.A)ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No RL. New Construction: Yes W No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta��kj�:� ' tante from nearest well-_,---------------Distance from foundation__.---__--__.--_--_.Material_--___-__--_--__-_--.-___----••-.-.------_..__. _.. ❑ %,U compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- Disposal Field: D' ce from nearest well_.--------------Distance from foundation--------------------Distance to nearest lot line................. ❑ e f lines-----------------------------------Length of each line------- -------- .........-Width of trench------- ------ Type ' filter material-------------------------Depth of filter material-----------------------Total length............................._.......... Seepage Pit: Distance to nearest well..__ .._�0_._Distance from foun�ation.____ Distance to nearest lot line___ d_.__ Number of its.--_--_ _ `� �. p -------------Lining material__�.Ca.wZ-u.:�ik�t+�: Diameter----��--- -Depth---,'►1'_-%6---�.-.--------- Cesspool: Distance from nearest well-----------------Distance from foundation----.--------------.Lining material__-_.--_.--___--_---_.._.___.._______. ❑ Size: Diameter--------------------------------------Depth------------------------------ --------------......Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building,_-_--_-_-_--.--___-•-•-_-----_----_--_--. ❑ Distance to nearest lot line----------------------------------------------- --------------•-----•--------•---------------••--•------•-----•--------••---- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------••-•••-••--•--•••...................................... ----•------•------------------------------------------•-------------------•------------------------------------------------------------- ----------•....................................................... ------ -------------------------- ---------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin�q !!fy ordinances, St aw and rules and regulations of the San Joaquin Local Health District. (Signed) ••••-�.---•-----.... - ------' t �—y' � ner and/or Contractor) By:. --------- (Title) ---..... ----`- •-•••-••------••-- - (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------------ BUILDING PERMIT ISSUED ---•••... ... - DATE...................... Alterations and/or recommendations----------------------------- --- -- ---•-----••••••...............................--•-•-- i- -- - --- -- --- }\ -- ....•--•----•-•-------...--•----- --------••-----....._........------------........................ --- ----•--•--------•-------•--•-----•-`-----------------•----•-•----•-----------•- •--•----•-------•------- c FINAL INSPECTION BY------- ----- ---- "- -------------------------------- Date.------ ._ _...1_.. J._ 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' 145446 ATWOOD