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APPLICATION FOR SANITATION PERMIT Permit No. 1 .3 (Complete in Duplicate) Date Issued ____ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install erein described. This application is made in compliance with Coun Ordinance No. 549. r4 d' T70� .4 JOB ADDRESS AN LOCATION. - ....L2_.a /Tw"^ �"' ----- Owner's Nam��e// - -- -- • ------------------- - "1 -------------------•--- Phone ---•---------------------•---------- Address....___G/ "� Contractor's Name -- ``^�-- '+�, "'`' Phone - ^� �� n� In will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 9�—^ 1v Number of living units: -------- Number of bedrooms -------- Number of baths _2�, Lot size ___ -f____________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table _�{_____ ft. Character of soil to a depth of 3 feet: Sandravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan 0 Previous Application Made: Yes ❑ No 6-�ew Construction: Yes F TYPE-OF-INSTALLATION AND=SPECIFICATIONS:. (No septic tank dr cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well�49_.-.---Distance from foundation___ _`�______.Mate�ial_.____._____________________._________ &-- No. of compartments____--------------Size-:S_6-_-A JC--------Liquid depth.... . . Capacity_f�4`'__------ Disposal Field: Distance from nearest well-_J-0.......Distance from foundation----.f- ........Distance to nearest lot hne._S_.r____-__ ��. Number of lines-------- _._ Length of each line_,`[dF- --'----______-Width of french.__4NY--------------------- Type of filter m� ....__._____Depth of filter material----/9._t---------Total length____Y�__p__^-----:'�"' ----- ---- ._ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line__.__.___________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------,--------. ----.Depth:__-.......-_—"---------- Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining materia---------------------.___________,. ❑ Size: Diameter----------------------------- ------- Depth-----------------------------------:----------------Liquid Capacity----•------------;------ gals. Privy:. Distance from nearest well----------------________________________________ Distance from nearest building._._-_.______.____.__._- l-_______________._. ❑ Distance to nearest lot line ----------------------------------------------------------------------------------------------- I. .11 Remodelingand/or repairing (describe):--------- - ------ ------------------ ----------•-••--------------• -------------------------•----------------------------------------------------- E --------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------••---- ------------------------------------------- ----------------------------------------------------------------•-----------....-----=------------------------------- ---------------------------------------------------------------------------------------------- j ----------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, an rules and regla+ions of the San Joaquin Local Health District. (Signed)'. ------------------------------------( "for Contractor) -------------------------------•------------------------------- -(Ti+le]_ -.:---------- --- --------- .----- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY--- --- --------------------------- - ------------------•-•-----------._ DATE-------------- ---- - --_-{-�----------------- - REVIEWED BY-----_.________- --------------------------- -------------------- -----------------•--•-------------------- DATE-------- -t;- BUILDBUILDING ING PERMIT ISSUED-----------------------------------------------V--------------------------------------------------- DATE--- ----- ---------•---------------------------------------- Alterationsand/or recommendations--------------- ----------- --- --------------------------------------------------------------.------------------------------------------------------------- ------------------------------------------------------------------------ -- ---- FINAL INSPECTION BY--------------- _._.-"i ti - ---------------------• Date------------------------- SAN ----------- -- ---------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-ZM 195446 ATWOOD 1Z-54 - -