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y APPLICATION FOR SANITATION PERMIT Permit No. ......7-!••-1••--- 1 (Complete in Duplicate) Date Issued 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. 5� --------------------------------------- JOB ADDRESS AN LOCATION......... 1 -- ' - Phone------------------------------------ Owner's Name-----i /✓icy�` �� <� G- ----- - Address G� ----------------------------------------------------------------------------------•---------------------------------- > ----------- - Contractor's Name---- ---_Ct/iN!�t�,----• --� Installation will serve: Residence g Apartment House F1 Commercial E3Trailer Court ❑ Motel El Other ❑ Number of living units: _/---_ Number of bedrooms _;t- umber of baths ---/-- Lot size -----AFQ------X---- _ Water Supply: Public system U;- Community system ❑ Private [Z Depth to Water Table JZ� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No [& New Construction: Yes [-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)" , - �7�G1------.Material_�__ _-.-�c��'�-�1�--------- Septic Tank: Distance from nearest well___�Z....---Distance from foundation_-..__.__ Capacity (p___Liquid depth_____6_$------------ t�ii No. of compartments---- -----------------Size----��--�-� - - P tY------ 5�` ��----- Disposal Field: Distance from nearest well.___fP.t2.____.Distance from foundation___ Distance to nearest lot line<i__/__ _____ Number of lines--------- Length of each line____-___��--"-Iv, -Width of french-"___�_.9L_:-__.------___ Type of filter material-_h�____-_5_.)&Depth of filter material------ length-_______ D_._________ Seepage Pit: Distance to nearest well--/0------------Distance from foundation___-_:�✓�______.Distance�o nearest lot line.___%________-. __Linin material__ _ zg. Diameter_____ . ___-__-Depth------SZ�-------------- Number of pits--------/--_ 9 Cesspool: Distance from nearest well-----------------Distance from foundation.__.----- Linuid Capacity Igals. ❑ Size: Diameter--------------------------- ----------Depth--------------------- ---------------------------- q ------------- Distance from nearest well------------------ ------------------------------Distance from nearest building--_---.___.-_._--------------------------- Privy: 1 Distance to nearest lot line______________________________ El 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 ordinances, State s, a rules and regulations of the San Joaquin Local Health District. T ` c (Owner and/or Contractor) l Si ned `��-�� --------- --------------------------------------------------------- ( g 1 ----------- --------- (rtl ----------------- e)----- ------------------ BY (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_------.----------------- _... ----- DATE--------------------- ---------------------------- REVIEWED BY --------------------------- DATE----_... ._�__ ----------------------- -- BUILDING PERMIT ISSUED__"-•--_____-".-_"-_--___------------- ____ --- --------------•-------------------.._..------------- D - --_--�"---------------------------------- Alterations and/or recommendations:----------------------------------- -----------------•---------------------------- --------- ------ -------------------------------------------------------------------------- -------- ---- FINAL INSPECTION BY:. 4v - Date- -q-- IQ -----•---•---•------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 13 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, Californiae- Er9-2M 145446 ATWOOD 12-54