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1 2 " APPLICATION FOR SANITATION PERMIT Permit No. .....r..... �l (Complete in Duplicate) :,/`T.� Date Issued ---_.!� ./.�G 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. 544 qq JOB ADDRESS AND LOCATION:. -�1.. c Owner's Name= .••• - Phone Address _ / .. Contractor's Name-----� .• ' Phone Installation will serve: Residenceartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I-__ Number of bedrooms .2— Number of baths ..r.... Lot size..._ ., ................................. Water Supply: Public system 4_ ommunity system ❑ Private ❑ Depth to Water Table 4'A_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No fl4-- -ew Construction: Yes ❑ No [9--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- _.Distance from foundation___t•e.........Material---- __________ __ _______ ________________ No. of compartments------.�--------------Size.SP__A_._A........Liquid depth_.--.-..�y_;_ --------Capacity....8'.Q.j;:�....... . Disposal Field: Distance from nearest well_Distance from foundation-_---Z -.._....Distance to nearest lot line....S......... Number of lines--- ---------Length of each line------a4 _______________Width of french--2-IL/ Type of filter material__.-_� _`._�__.__Depth of filter material-----�8.-.�______Total length.......... p........................ Seepage Pit: Distance to nearest well__--__...Distance m foundation_ Al.p-....—Distance to nearest lot line____-____- Number of pits----1--------------Lining material.... -Size: Diameter..'...........Depth...4e----------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material_____ ______________________•:•-- ❑ Size: Diameter------ -------------------------------Depth--------------------- ------ ----------------•-----Liquid Capacity--........_......---.---•--.gels. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------................................ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------- ------ : Remodeling and/or repairing. (describe)___________________ __ ____..._.._...................................... ........................................................ ---------------•-=---------•------------------..------•----------------------------------------•------------------------.------------------------------------------..._..------------------------------------------------•--- 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 Health District. -•-__O Contractor (Signed)------ --- - --------- -- -- ---- --------------------------- ----------------------------- ( �- ) By=------ --------- --- ------(Title)------------- --------------------- ------ (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 APPLICATION ACCEPTED BY - DATE ...................... BY------------------------------------__--------- ---- ------- DATE------------ "''` BUILDINGPERMIT ISSUED------------------ ------ - -------------------------------------------------------- -----•. DATE.------------- - . .............. -•---- --••---- Alterations and/or recommendations:--------- ....... .... Nl T .....................------ ----------------------------------- - --- -------:.�—------ . . ................... i .. -------------------- ______________________________ ________ ... ._.....__. ......_._______.____._....___ ---------------------•-•------•------------------- ---------- �� J 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 145446 ATWOOD. 12-5A