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0APPLICATION FOR SANITATION PERMIT Permit No. ------------------ Duplicate) ) Da�te Issued ---.-__--7----- ,_-- 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 _ Owner's Name_________________ - -• --•- ----------- --------------- ------ -- ------------------------ ------ Address_------------------------------ -----Address--------•----------------------•- Contractors Name----- .....'----- --- 1 ------ _ ----------------- phone Installation will serve: Residence Q�partment House ❑ Commercial ❑ Trailer Court ❑ Motel [IOther ElNumber of living units: __/___ Number of bedrooms -34 __ Number of baths ._ __ Lot size _____ �� _ --- Water Supply: Public system Community system El Private ❑ Depth to Water Tabled ft. Character of.soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-Har4an ❑ Previous Application Made: Yes ❑ No [ New,Construction: Yes ❑ No 19�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank"or cesspool permitted if public sewer is available within 200 feet.) I pti Tank: Distance from nearest well__;______________Distance from foundation---------- Material________.__._.__.__. _ .____...______-__.__ .___. No. of compartments --------- ----Size------•-------------------------Liquid depth-------------------------Capacity------------------------ u ,Freld: Distance from nearest well_________________Distance from foundation----------------------Distance to nearest lot line____________-___. Number of lines-----------------_--------------._Length of each line_,_`-------------------------a Width of french_------------------- Type of,filter material________________ ________Depth of filter material__._______.___._...'_!Total length_--___________-____.._____________--_.__ Seepage if: Distance to nearest well�_Distance om f ndation_ .�� . �j 3C9..._____..Distance to nearest lot line____._____.__... [R Number of pits.___---------_--lining material__ J ( Size: Diameter__?--- .-_____-Depth._e?,�!--•--------_----- Cesspool: Distance from.nearest well------------------Distance from foundation._____.-------------Lining material,-------------__-___.________--_-____ ((� ❑ Size: Diameter---------------------- ---- - -- ------- -Depth p --------- ------------------------------ -----Li Liquid Capacity W .. . _ -� � 9 P tY- ----------•----- ---------gals. Privy: Distance from nearest well_____________________---------------_--------.-Distance from nearest building -------------------- ❑ Distance to nearest lot line.----' - -° _.- y Remodeling and/or repairing (describe) -------------------------------------------•-•----------------------• > ---------•------------•--••---------•------------------------- -••--------------•----------------------------------•----------•------------- U ----------------------------------------- ---------------------------------•----------------------------.__._._.- -------••------------------•---•---------------------•------------------------------- ---------------------- I hereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat6la-Wwws, and rules and regulations of the San Joaquin Local Health District. 9 (Signed)------------ ---------- -------- •-- ner and/or Contractor) i ` By:-----------------------------------Pcafloiti t-�-�-------- -• ,/��-��r-;-`-�--�.---�------------------------{Title �=.- �- -• ��.1�� . (Plot plan, showing size of lof, of system in relafion wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- -------------------------------------------- DATE-------- J REVIEWED BY-------------------------------- --------------- BATE `- BUILDING PERMIT fSSUED. = -------------------------------------------------------- DATE----- Alterations and/or recommendations: - - - -- - �----------- -- ---------•--•------..,------•---- ------•---------------------- ---------------------------•---------'-------- ----------- ----- -- ------- - - - - - ------------- - ------------ ------- --bra----- __ ---------=--=------------------------------- -----• FINAL INSPECTION BY:_� = Date ! L J -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 1z-64 -4;. __