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r: APPLICATION FOR SANITATION PERMIT Permit No. ....7s3 ' D (Complete in Duplicate) 3 ?j I lJ Date 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. 1(16 JOB ADDRESS AND LOCATION......._ %5__�•_____G_.._ ___... 1 ?-7�............................. Owner's Name-- -------- ------------- ....-;1.2Lt.:m---- 4 ' Address.........3 .........e.;------=... . . ..............---------------••-------"------••--•---------------------------------------------••--------------------•---....---- Contractor's Name - - - ---------------------------------•----- .---------- Phone.,,) .rz._lf�d 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Q Number of living units:/...__ Number of bedrooms Number of baths ..../__. Lot size —:5-0 _... .-_1.......?____________________ Water Supply: Public system .Community system ❑ Private ❑ Depth to Water Table 44 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q_ Hardpan ❑ Previous Application Made: Yes ❑ No 4— New Construction: Yes J& 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-_- l!?u—Distance from foundation...IQ...........Material... ....... (� No. of compartments........ --------_...Size.,.��__ :_--Liquid depth__..,(,_.e-------------Capacity---- _____-_- Disposal Field: Distance from nearest wellfrom foundation.-�7_-------Distance to nearest lot __ ____ ______ Number of lines l ,- -Length of each line______•� dd Y ..Width of trench ¢' --------------- Type of filter material__j_�--_-.�l-epth of filter material__--_/---- --._----Total length..........1�---------------- Seepage Pit: Distance to nearest well __ - -_Distance from foundation...... _b......Distance to nearest lot line__ ________ [ Number of pits..._-----Lining material_ ,-Size: Diameter___'!' .'j_- 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----------------------------------------------------------------------- Remodeling ------------------------------------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, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed) =' �G - ----- ��- R - ( ner and/or Contractor) By:. � �"'� s � L/ (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 __ ____ ________________ Alterations and/ors recommendations:-------------- ---_- _-- . - .............................................................._.•_ ----- --------- --------\' '' ` -= ` ! : ----------•-------------------------------------- --- ------------------------------------------------- --------- --- ------------------------------------------- ............................................ ................................. FINAL INSPECTION BY:----- _. .. ..0 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