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77 i 4 APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) Date Issued ----V/0Z Appliceion 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 ADDRESjA CAT N . -------.JY----- -- C� ------------ s Name __ Q G,J C q --- � - -------------------- Address ------------------ - Phone------------------------------------ Owner' Address________________- Contractor's Name.---- �.X 'J.H---------- �"��'8---------------------- ------------------------------ ----------- .. Phone----------------------------------- Installation will serve: Residence [A--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 7 Number of living units: ________ Number of bedrooms ___Number of baths ---L. Lot size ____7 __�. --_! - d - --------------------- -- Water Supply: Public system D—torrimunity system ❑ Private ❑ Depth to Water Table LU ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®--H-ardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No TYPE --- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: r Distance from nearest well-----------------Distance from foundation------------___-----Material _---_________..___._---______.___._-._--____. ❑�1l'SfNj No. of compartments------- -- - -----------Size----•---•------------------ ---Liquid depth------------------ --Capacity----------------------- Disposal Field: // Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line-------.____..__. ❑ C��v�� Number of lines----'-----------------------------Length of each line---------- --------------------Width of trench Type of filter material-------------------------Depth of filter material------------------------Total length--------------------------_----_, /� �or Seepage Pit: Distance to nearest well...-Q_4/.5._.Distance�ff� foundation.-t-_____________.Distance to nearest lot line__------ _. Number of pits..____;./........__Lining material--- ---Size: Diameter__._3 �� Cesspool: Distance from nearest weEl__________.__-_Distance from foundation--------------------Lining material-- ❑ Size: Diameter---------------- - --------------- --Depth-------------------------------------- ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest yell.......------------------------------------------Distance from nearest building_.__-___-----____-_______------- - ❑ Disfance to nearest lot line____-.._. - Remodeling and/or repairing [describe):_._. __-. -'_-_-____ ._ _- _ _ - -- /V N ---•--•--•------------------------•------•---•------..._ ---- -•---------•-••------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staf ws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ------ rPxlI sxl _ /VC r ----- -------------------- er and/or Contractor) By;.....1-4 . A ------ - ------------------------ -----------------------------------------------------------(Title)--- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- -----•----•-----------•------------•--- DATE----- — -------- ---------- -------------------------- REVIEWED BY---------------------------------- ------ DATE-------- - - --------- ------------------------------- BUILDING--P--E--R---M1__IT ISSUED------••------------------- ------ -------- -------------------------------------------------------- DATE---------- -- Alterations and/or recommendations:. -------- --- ----- ---= ---------- -C; --- - --- - - -- .- -- ••-------------------•------ -------------- -. J '0 ------ - ------- T - - ----------------------------- --------------------------------- -----------------------------•-----------------------------------•---------- FINAL INSPECTION BY----------------- - --1-S,------------------------------------ Date_.....—+ } --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I'! E5-9-2M 145445 ATWOOD 12-54