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' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S Date Issued _../'-I—.-_--- Applica+ion is hereby male 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........ - - -� cS d ` Owner's Name_-_. -------- ------------- --- - Phone -- - - --- -------------------------------------------------------------------------- Address------.2-4--'a C Contractor's Name---/. ------- -- � .._---- -------------------------------- Phone _,., 017 Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l-__ Number of bedrooms -.Z-- Number of baths .-,/_ Lot size .--.t d_..-...X-_� -5�--___-_____ Water Supply: Public system ❑ Community system ❑ Private jj --Depth to Water Table .&/-Oft. 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 W No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan4sa r pool permitted if public sewer is available within 200 feet.) ncefrom nearest well _.-______.__Distance from foundation__._-_-----------Material 4` No. of compartments--------- - --------------Size--------------------------------Liquid depth----------------- -------- Disposal Field: Distance from nearest well---_------------Distance from foundation--------------------Distance to nearest lot line----------------- 171 Number of lines----------------------------------Length of each line------------------------------Width of french Type of filter material-------------------------Depth of filter material _________-------------Total length------------------------------------------ Seepage Pit: Distance to nearest well__/;;�0 --_-_Distance from founcledion------�D-�•-.-.Distance to nearest lot line..Z.d:�)_-_- Number of pits------/---------.__Lining material__.- Diameter_...` Cesspool: Distance from nearest well.................Distance from foundation___..__.____..___.Lining material--------------------.------------- ❑ Size: Diameter--------------------------------------Depth---- ------- .---- --------- - -----Liquid Capacity----------- ._. gals. s Privy: Distance from nearest well____-____.___._____________________.-_-_-Distance from nearest building.-__..__._._....-_.--._-..._____..-.__..-. ❑ Distance to nearest lot line Remodeling /or repairing (describe):------ ----"''`-- -------------�✓� _< �o-- -�r------ -•-----a-�'-'t -----------------------------------------------------------------•-------•---•-•---------------------•--------- ---------------------- -- ----------------------------------------------------------------------------•-----------------------------------------------------------...----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S_fatejo nd rules and regulations of the San Joaquin Local Health District. (Signed------- /l._�_- (Owner and/or Contractor) BYt -= =------ _ (Title). (Plot plan, s wing size of lot, location of system in relation to wells, buildings, etc., can be placed on r verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_'15.1.--------------------- ---------------------------- ---------------------------------------- DATE..S' .�...----------------------------------------------------- REVIEWED BY ------------------------"4.- _-- --- DATE---w. BUILDING PERMIT ISSUED-------------------------- t ------------------------------------------------------------------------- DATE------.,-: ""`"---------- Alterations and/or recommendations:-------------------------------------------------------- ------------------------------------------ ----------------------------------------------------- --------------------------------------------------------------------------------------------------------- ------ - ------------------------------------------------------------- ---------------------------- Y - ------------------------0-------------------------------------------------- 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 E5-9-2M 145446 ATWOOD 12-54