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APPLICATION FOR SANITATION PERMITit No. ..... L 3- 4^ 1 D (Complete in Duplicate) �CA� 4 P ate Issued 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. 549. JOB ADDRESS AND LOCATION......... .."T.�_%t-9-- -- --- ------------ ------------------- Owner's Name..... - _-- ....--..-... - -- Phone.- ------------- - - - Address------ --�12-12 - = - Contractor's Name--------- -- - - --� ---�- --------------------------------------------------------- Phone------ -------- - --dry Installation will serve: Residence IX_,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �_... Number of bedrooms _1,. . Number of baths ...1_- Lot size ..-_.. � Water Supply: Public system ❑ Community system ❑ Private WI_ Depth to Water Table -1,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( Hardpan ❑�` Previous Application Made: Yes ❑ No ❑ New Construction: Yes J�L_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q e (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: , Distance from nearest well---------_ ....Distance from foundation----------.--------Material ___..- __- ❑ l�of compartments .....__ _Size... .. ..---------. Liquid depth--------.---- ---.-------Capacity _._. ---- --------- Disposal Field: . Distance from nearest well _...Distance from foundation- -. ......_.._Distance to nearest lot line---------_------ D �mber of lines....___.. _._....._Leng+h of each line_........___....__,-...._.Width of french ................._--------- 7 pe of filter ma 1 _D-.....___ ... _Depth of filter material---___.._----...._.Total length............._--_.-...__-------.------- Z� r Seepage Pit: Distance to nee a ._. _. 4> . ....Distance f o fo ndation.---1,4�------.Distance to nearest lot Iine__�:.q../_ Q Number of pits....../_...._._-. - ng material_. .._n_. v.8 e: Diameter...:..�-3" Depth..... _�'2. Q_------ Cesspool: Distance from nearest well----- ----------Distance from foundation. Lining material.. -----_.-.--__._-__.__.- ❑ Size: Diameter_..__ -------- --------------Dept h---- - -------------------- -------- ----Liquid Capacity-----------_-----------gals. 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 Health District. (Signed)---- "`-3r_-.- ------------------_------------------------------------(Owner and/or Contractor) Br• - -- - -- ----- --- -- _.rile (Plot plan, showing size of lot, locafion of systeminrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._�t - --------------------------------------- DATE.-------------------- REVIEWED BY--............-- ----------- - -------- DATE -- ------------------ - - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE__711 ------------------------------------------ Altera ionsVor cammendati ns:- --.....__. . ------------- --------- ------------ - ___ - --------- ------ --------------------------------------- ------------------ -------------- ................------------___-- - ------------------ -------------- [ ---------------- -------------- ------------------------------------------ ------- _ ............._ ------- ----- ------------------------------------------- -- _..------------------ - .. . - -- - --------- - - ------ ----.-..--------- FINAL INSPECTION BY:..�, �-_.-_--,— Date 3 4& � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak St,eet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ssl—.m 145446 ATWOOD ,z 11