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V f APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) 3 Date Issued ---- Applica4ion 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. I JOS ADDRESS AND F �,TION-_._` � _..._____ ''� _.______:_ Owner's Name--------- .. i___4 _ •_ - -----------------------•--- ---------- -- - - ------------------------------------- Phone---- ----------------------------- {� f Address------------- (1 .�-------------_----- =-- �. _ Contractor's Name------------= - ------ ------- ----------- ----------------------------- h el --------------------- Installation will serve: Residence ❑ Apartment House ❑ CommercialTrailer. Cour ❑ Motel ❑' Other ❑ JWd Number of living units: -------- Number of bedrooms ________ Number of baths ___ Lot size ____--t.�&_X , ------------------- ; Water Supply: Public system Z111"Commun.ity system ❑ Private ❑ Depth to Water Table X;V-ft •r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P9—'nardpan b-'__4 Previous Application Made: Yes ❑ No New Construction: Yes ❑ No V' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wet _h_t??'Distance from foundation-_--a-,49---___._.Materiac_ __________- No. of compartments----- , ___ �_____..Ca Capacity Y__ _-X_049 Li uid de th $// Disposal Field: Distance from nearest well_2?,��Dlstante from foundation__�� ..._Distance to nearest I t Iine._r.��_ i „ Number of lines_______________ _ Length of each line_______ _- - -- -------- g ?�------------Width of firench.----- -�-- r/F� Type of filter material. . Depth of filter maternal__A..Lw __,__._._Total length----------- --------------- _._____ _ _ o F i Seepage it: . Distance to nearest well.. 4/-►'Distance from foundation____----- _ 49 __ _________ Distance to nearest lot line___ ___-__--- IR Number of pits--------- Linir material__(24�--ft e ize: Diameter-9,F Cesspool: Distance from nearest well--------- -__-_Distance from fotindation--------------_----- Lining material__-__-_________________________-_ ❑ Size: Diameter--------------------------------------Depth-------------------------------- -- ------ ---------Liquid Capacity-----------------------------gals. N Privy: Distance from nearest well___________________N_-:_---_.___._.-.._..__.._._Distance from nearest building_.__.__._-.__._________--_____.._________. ❑ Distance to nearest fot line---------------------- -------------- ------- -•---------•------------------------------------------•---------------------------------------- . Remodeling and/or repairing (describel:-------- L +_.� eG, ---------------- -------------- ------•-------•--------------------------------------...-----------------------------------------=--•-------------------------------- A rs . ----- ------------------------ ---------------- I --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 and regulations of the San Joaquin Local alth Districf. (Signed).......... �r' "" = t� `'t -------------101 +"re�•on r Contractor) By: 4 (Title) /'' r (Plot plan, showing size of lot, ,tion of sys+em in relation to wells, buildings, efc., can be,placed on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- Y ----------------------- DATE.------ REVIEWEDBY--------------------------------- ----------------------------- ----------------------------------------------------------- DATE--- PERMIT ISSUED----------------------------- ------- ----- - -------------------------------------------------• DATE.- .----------- --------------- BUILDING Alteratio nd/o recomme dati ns: ---------------------- ------------------ ------- ------ � ' ------------ m -->------------------- : .. ---- -------------------------- ----- ------------------------------------ -' _______________________________________________________________________________________________________________________________________________________________________________________________________________ FINAL INSPECTION, BY:..---- --•c----------------------------------------------------------- 'Date-----_�- - ^----- -------------------------------------- ------- SAN JOAQUIN LOCAL HEALTH-DISTRICT ., 130 Soufh American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Streef �y Stockton, California Lodi, California Manteca, California Tracy, California R c ES-4 145446 ATWOOD _ 1