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V tr ((� APPLICATION FOR SANITATION PERMIT Permit No. ._...TS7Z__ �} (Complete in Duplicate) ,5 OA Date Issued ___.._,�7�sZ 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 L CATION_..___.._ A j - Vfl Owner's Name...... v ----- .._----._ -------------------------------------------- Phone.-------- ---------- --- � .- - - - ---------------- -------=----------------------------------------------- --------------------------------------------- Contractor's Name. .. o d`�-s. ------------------------------------------------------------------------------------------- Installation will serve: Residence G5_—,&partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms _--5- Number of baths _/_--- Lot size ----_._�.��2�... --------------------------------- ater Supply: Public system ❑ Community system ❑ Private [ZyDepth to Water Table .40t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe f2k_Hardpan ❑ Previous Application Made: Yes ❑ No E& New Construction: Yes (9 No ❑ (' TYPE OF INSTALLATION AND SPECIFICATIONS: p`w! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---�7v_...__Distance from foundation-_._0.-4-_c_ -_Material /-------- No. of compartments_.._.- ------------- depth__�__Q_-__--___-___capacity- ----5;�O-_v------- Disposal Field: Distance from nearest well---. ----__Distance from foundation__-_-�,Fr'2........Distance to nearest lot �. Number of lines-----------l__j__-,�-.__--._-__Length of each line-__.___Q� ---•�_ --� �� ---------.Width of trench----��__ --------------- Type or filter material---125_jQDepth of filter material_--_._l.S.____.._.Total length-------!1,5''_.--_____- ----------- eepage Pit: Distance to nearest well-. -----------Distance rom foundation_.__-` ___..Distance to nearest lot line__1 Number of pits__-__-I--__-__--_.-Lining material_- 1'j4: - ,!4. 'j4:�: Diameter-------�57 Depth-- Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material__--_-___._-_-----_..__-__.___.___ t ❑ Size: Diameter--------------------------------------Depth-------------------------------- ----------------Liquid Capacity-.---------•---------------gals. Privy: Distance from nearest well-------.___.-_.-_-------__---_ --_ _ _Distance from nearest.building ----------------------------------------- d ❑ Distance to nearest lot line------------------------------------------- ------------------•---_-_._ ---•------------------------------------ Remodeling and/or repairing (describe)_______________________________________ ---------------------------------------------------m------------------------------------------------------------------------------------------------------------------------------------------------------------ --- -- --------•---------------------------------•----------------------------•---------------•------------------------------------------------------•--------------------------•--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. (Signed)\_ ``� (Owner an Contractor) ------------------------- (Signed) --------- ----Vie.•-��_Y=r------ -------- ---------------- or on rector) ------------------(riitle)----- - ----- (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- REVIEWED BY .__-------------- ___ - --------------------------------------------------- DATE--------�........................................... ---------------------------------------- BUILDING PERMIT ISSUED ,"�`---------------------------------------------------- DATE------------7- --------------------- -------------------------- ----------------= J - DATE-------- Alterations and/or recommendations: ------------------------------------- ------------------------------------------------- �" ......................... I<-_. 1 ---------- /� }------------------------ ------ - --------------------- --- --------- ------- -- ------------------------------------ -------------------- 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 745446 ATWOOD 12-54