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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 421I.; Date Issued A- r 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.-----�_...........-- ...$ ----------------- Owner's Name YY__ = E _ _ -- L � V 10------ ----------------------------- Phone------------------------------------ -Address....-•-•---•-•----•-•---- •-•--......-•-- ------------` . --------- =--•------------•-------------------- .. .................................... Contractor's Name... -— Phon 4�_ _'�_._7---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of livini units: I---- Number of bedrooms __�1- Number of baths ---/- Lot size ..... __--_-_-•__---_----_ Water Supply: Public system ❑ Community system ❑ PrivatejK Depth to Water Table -------- ft. Character of soil to a 4 epth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ A obe 13C <Hardpan ❑ Previous Application de: Yes ❑ No �k, New Construction: Yes 5k No ❑ TYPE OF INSTALLATI N AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �dY Septic Tank: Di ance from nearest well-6-0._.Distance from foundation-----!®--------Mat rial--------------------______ __--__.... -' N of compartments.-_-._ -`�-.__._._---Size....•_5_k.�_x4-.-Liquid depth.............._---__ apathy.. �.�__ Disp�osyaI Field: Dis ance from nearest well___4Q--_Distance from found -_ ation. 44.0......._..Distance to ne rest lot line----- Nu ber of nes------------2 ................Length of each line-____-.�!.10_---_--_-_.Width of tren h......-'L�!�...___.r------ TyF e of filter mate rial____-__--_---Depth of filter material ___.._/1---------Total length.................I--�_�-o.......... Seepage Pit: Dis ance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 1771 N ber of pits----------------------Lining material-----------------------Size: Diameter-----------------------Del 4h--------------------------------- Cesspool: Di tante from nearest well-----------------Distance from foundation--------------------Lining materia-------------------------------------. ❑ Si Diameter----- -----`------------- -----------Depth-------------------------------- ------- ----------Liquid Capaciy............................gals. Privy,, Di tante from nearest well------.-----------------------------------------Distance from nearest building-_•_-----............................... ❑ Di Lance to nearest lot line.-.-----------------------------------------------------------•-•--•-•-----------------•---------------- Remodelingand/or rEpairing (describe):----------------- -----------------------• --•----------••---••---•-----•-•••••••--•-•-••---••••------•........... ----•--•-----•----•-•-----------•--- .......................................--------•----•--------------------••--•-------•-----•----•-------------------------------•------•---•-----------•--•------------------•--•--•• -•---•--•----------------- --•--- -----••----------•------------•------- --------------------------------------•----•--•-••••-•-------•-----------•----------•------•-----••-•--••-•----•------------....-------•--••-• ------------•-•---•-•--------------- ---------------•-------------------- - --------------------------------------•---------------•---•--•-------•----------------------•---••--•----•-----------------•-•-------------•--- ....... ----------------------------- I hereby certify fl iat I have prepared this application and that the work will be done in accordance wit San Joaquin County ordinances, Stat lal,IAI rndles and regulations of the San Joaquin Local Health District. (Signed)--•-• - ------11----------- ----------------------------------------------------------------------(Own iir and/or Contractor) By:. .---••--- -------------------------------- -------------------------------------------------------------- ..... (Title) (Plot plan, showi size of lot, location of system in relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY APPLICATION ACCE TED BY_____ __________ ..- _--_ __. .__ ._____ _._ DATE.............. - ------------------ -- --- --- ---- ----------------------------------- --- ---- --- 1� REVIEWED -------------- REVIEWED BY.:: ,� ------------------------------- --------- -------- ----------------------------------------- DATE---------------- --• ..................................... BUILDING PERMIT IS UED --------- -------------- - DATE Alterations and/or re ._.: ---- --------------------------••-•-------- ---------- ---------------------------------------------------------------------------............ ----------------------------------- --------------- --------------------- ----------------------------------------------------------------------------------.......................................................... FINAL INSPECTION BY:.-��w-------------------------------------.......... Date- 11.. r--- 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 1 ES-9-2M 145446 ATWOOD 12-54