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,� 1P APPLICATION FOR SANITATION PERMIT Permit No. .p'3.f�y.... / (Complete in Duplicate) Date Issued 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 (5; TIO _.. -- - ---- 1 -G =l ' 1 Owner's Name........ ��F^lr ----- Phone............................. Address------------/,/37Ar....... Contractor's Name = - =�---- , - � Phone................................... will serve: Residence 8- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _Other ❑ Number of living units: _ _- Number of bedrooms X. Number of baths ---`"9_ Lot size __r `l,X...1 Water Supply: Public system effV6iunittr-system ❑ Private ❑ Depth to Water Table -�_ ft. am Cla Adobe Hard n Character of soil to a depth of 3 feet: Sand:z❑ Gravel ❑ Sandy Loam ❑ CIa)4,'� m ❑ y ❑ pa ❑ Previous Application Made: Yes ❑ No '"New Construction: Yes "o El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer 4 available within 200 feet.) `"Distance f om foundation... Materi I_ �: Septic Tank: Distance from nearest well.- _f j �/`` n If.._... - _.._ . No. of compartments-_-- -_..............Size...,�_6lf..X.q.-(.'_..Liquid depth------ --------- Capacity--__, - .. Disposal Field: Distance from nearest well X "istance from foundation XOP.._.....Distance to nearest lot line � Number of lines--------/ Length of each line____ f_ < Width of trench_•__ Type of filter material Depth of filter material----- -----.Total length...=--...7-_� ------ Seepage Pit: Distance to nearest well. _ -- --�--`----- istance from found tion----7,0 -..Distana a to nearest lot line _ [ � Number of pits._-_-,�------------Lining material. ize: Diameter.�..�._f.-. .:.--Depth-.-_-.- _4A................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__--_----___-_-__-_-____-•--___-_-_--. ❑ Size: Diameter---------------- ------------ -------Depth--------------------------------------------- ------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_-_-__-___•..._--_____----._-.---__-..__. ❑ Distance to nearest lot line----------------------------------- --------------•---•---- •---------- ---•--------------•----------••----------- Remodeling and/or repairing (describe) e-1:�7 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------•---------------- 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. (Signed) r / .' �- -/ ° -"--- --- (Qwhersad,LacContractorj By:........................................... ----- ---- Title--- r (rifle) (Plot plan, showing size of lot, locat' `i of system in relation to wells, buildings, etc., can be placed on reverse'ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - --- ---- ------------------------------------------- DATE.............. REVIEWED BY - - ---------1 ---------------------- DATE ............[..--- BUILDING PERMIT ISSUED---------------------------------------- --------------------- ------------------ DATE----------------------------------------.................... Alterations and/or recommendations: ---- -i,,,;.,;ire , --- ----------------•-------------------------------------------•-----•-------------------- -----_ ------------ r r ----- -----------------------------------•------.----------•---..................................... -- -- - ------------ --------- - --------' -�-,rL '..: -.�1`) ------�_�- `�- ------------------------------------------------------. ----------------------------------- -- ------------------------------------_. ------ - --- - ---------------------------------------------- -•------------- ..-----...------•-----. --------- �ji.. j FINAL INSPECTION BY:.----- �----- - --------- - ---- D te_ AP? •-•- ` --- �`F'--------------------------------- SAN JOAQUIN LOCAL/HEALTH DkSITRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATWOOD