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Y APPLICATION FOR SANITATION PERMIT Permit No. ._.7 _f_ (Complete in Duplicate) Date Issued _/,/�/az__. Applica4-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 dinancer 0 .lr5 �f JOB ADDRESS LO ATIO ;_ --------- f� ( LVLT'� Ck /'�/, G Owner's Name__________ ' err T tr-- ---- ----------------------------------------------- ----- Phone l ----------- Address______________ _ 1 Contractor's Name..(r"' � - ----------------------------------------- Phone---------------------------------._ Installation will serve: Residence Apartment House ElCommercial [ITrailer Court E] /Motels❑ Other Number of living units: __I_-_ Number of bedrooms -2-- Number of baths ---/--- Lot size -----(L�_ X j 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&-"Hardpan E]Previous Application Made: Yes El No � New Construction: Yes NE] E]o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic,,T64: Distance from nearest well_.,V_4' istancg fro four tion__._ _ t X cel -- -------. ate,al----- -------------- No. of compartments / --- p -„Size_ Liquid epth `t"---------.CapacitY.----- r� Dispos Field: Distance from nearest wel_ t-"__ - --- `��Distance from foundation lQ_.__.._ . .Distance to nearest lot lin ._� "Ylt.t..y2� Number of lines.__. _.t'".__ 'Length of each line-___ _ ...____... 9 1_- _ Width of trench------- -- - -- ------------ Type of filter materiae epth of filter materia L______f_ -------Total length-------------I --------------- Seepage Pit: Distance to nearest well---____---------------Distance from foundation--------------------Distance to nearest lot line------------- ❑ Number of Pits----------------------Lining material-----------------------Size: Diameter--------- __._ Cesspool: Distance from nearest well----------------- from foundation_-------------------Lining material-----------Size: Diameter-- -----------------------------Depth------ --- Liquid Capacity -- -----------gals. Privy: Distance from nearest well-_________.-____ .-____..__---------------_-Distance from nearest building.----------------------------------------- F1 Distance to nearest lot line--------- _______ Remodeling and/or repairing (describe):----------------------------------- ----------------------------------------------------------------------------------- (� ------------------------------------------- e y I- ---- -- - -- ------ --------------------------------------------------------------------------------------------------------------------------• ---- I hereby car+ify that have prepared this application and that the work will be done in accordance with--S..an Joaquin County ordinances, State laws and led r a dregulations/ f the San Joaquin Local Health District. (Signed) - = y ! ------------ ------(Owner and/or Contractor) --- ---------- By:------ --------- (Title - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------------- -------------------------------------------------------- DATE--,];— REVIEWED BY -;— -------------------------------------------------- I IS UE - - DATE----�•-R------ r - - BUILDING PERMIT ISSUED -�------- ----- Alterations and/or recommendations:--- DATE_.._..._. ------------------------------ --------------------------------------------11---------- --------------------------------- --------------------------------------------------------------- FINAL INSPECTION BY: �-�-' --------------------------- Date--- SAN ate--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