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1 APPLICATION FOR SANITATION PERMIT Permit No. ..,.7. y. 42- 1 (Complete Duplicate) Date Issued ...,/F/�__ 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 Ordin e No. 549. JOB ADDRESS LOCATION... ----------------------- Owner's Name--- ----------- ,�L ---------------- -------------------f------------------ Phone.................................... Address---- f. .....-- ------... - ..........................----------------- Contractor's Name------------ - -- . -- -- -_ - Phone Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l__ Number of bedrooms _r-.- Number of baths __/__ Lot size . .../ZZ.. .................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e]---Hardpan ❑ Previous Application Made: Yes ❑ No g3` New Construction: Yes ❑ No [t}- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0302 Septic Tank: Distance from nearest well�-_)I&IIADistance fom foundation___xg. ..._.Material...---- [ - No. of compartments--__.Qi __-Size_ _X -__-Liquid depth___4/�--`---. _-___--_Capacity._.. Disposal Field: Distance from nearest well---/70V-Distance from foundation._-_��._'�----------Distance to nearest lot line..9.......... _ Number of lines-----_:.f_________ ____ _____ Length of each line------ . .a__ t__.Width of trench------- ._____.__---_______ Type of filter materi -Depth of filter material--------�0C? ...-Total length---------- ----.................... Seepage Pit: Distance to nearest well----X_�i1 Distance from fou ation.-_ .........Di nice to nearest lot line_______________ Number of pits. ?-_--------Lining material-Of f 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--------------------------------------•---------------------•---•-•------------•--••-------------•----- •---------••------------.----- Remodelingand/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)....................-� .. '� ... 's'+c.' ` -----------------------(�eeee■�I it Contractor) Z;* ------------ By:------------------------------------------------- Vit/ --------------------_(Titl ? " (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on never ' side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------------- ----- --- ----- ------------------------------------------------=---- DATE-------;7------------.........._......-- REVIEWED BY DATE -- BUILDINGPERMIT ISSUED----------------------------------- ---- ---- --•------•-------------•--------••--•---•- ---•-- DATE------------- 1 Alterations and/or recommendations:_______._ __......._ __ __ ___ _ ------------ .1;-..._ .... ..:... . ,-/ -- ..•••--•-- ---- ----- ------------------------------------------ -------- ----------------------------------------------------- FINAL INSPECTION BY:-.--- S Date I ) IT---•��------------_--•---... 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 ..