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APPLICATION FOR SANITATION PERMIT Permit No. ..lO......a. (Complete in Duplicate) -► 1 I �: Date Issued ____ .__I___ 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. AR19-77q Z4! T 45 164 �JOB ADDRESS AND LOCATION] SW_ . ..._. . .._.A Owner's Name FN!�- - DG = © -Q---------- ----------------------------- -------- Phone---------------------- Address------------•------•- t11ftA !tJE......... ............................. � . .....................Contractor's Name : nG. �r Q' Pone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------- Number of bedrooms,..3.. Number of baths ... Lot size ................/DO. .__ D._._________.._ 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 Loarry)K Clay ❑ Adobe„dPr Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes 0 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-----------Distance from,foundation..._.1.?.......M t�erial__--------------------- ------ No. of compartments--------Y-----------Size.....�S�Qys........Liquid depth-- ---,dL(,�o__CapacitY--.-- Q------ Disos I Field: Distance from nearest well. Dt__Distance from foundation-------l2_'___..Distance to nearest lot line__...........__..__. Number of lines-------------.__ -_. Length of each line............?••?`—---------Width of trench-------------� __`!._____._ Type of filter material.__.___ _ ". _Depth of filter material.-__.-__-?8-------Total length-------------------7-5-------___.__ See pa a Pit: Distance to nearest well___ -__Distance om foundation....... o_f_..Distance to nearest lot line........`.......... Number of pits--------l-_________Lining material... C!;%K------Size: Diameter-___.1',3.1 ___.Depth-------A$___'______________ 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 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 ordina to laws, and rules an regulations of the San Joaquin Local Health Distr' t. (Sign --- •---•--- •. . . . - --- ---------------- ------------ M-",,6,4! 1 f---l``_- CqOwner and/or Contras or) iFA By:--•---------------------------•••----•-*-.......... ` ------ -- - ---------------- (Title)�`�_ _._ --------- (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on referse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------------------------------------------- DATE - / REVIEWED BY----------------------------------------- ------------•-- DATE J -------------------------------- BUILDINGPERMIT ISSUED-------------_--- --------------------------•----------•---------------------------------------- DATE............................................................. and/or recommendations------------------------------------------------------------------------------------------------------------- ••-----•----....•----------•---------------------------------•---•---•--•--• ----------•---•----_....--•-----------•--------------•------•---•-----------•-••--•-.._......................................................... ---------------------------------------------------------------------------- --------- ---------------------------------------------------•-......-----...--•-------•------•---•-•------------......-------•--•-------..... ----------------------- --------------------------------------------------------------------------------------------------------------- --------------------------------------------- -------------------------------- ------------------------------------------------------------------------ ------------------------------- ;;,;v........................... FINAL INSPECTION BY:-- --- -------------------------------- Date---------------------- ................................------------------------- 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