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d - APPLICATION FOR SANITATION PERMIT Permit No, Q--�, �.. (Comtete in Duplicate) >¢/ p p ) Date Issued __..f�!'ah_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 L QCATION............ '------------t'-h1qw ._D ----�� IQ �S_..._ 1 '� Owner's Name-------------- - -R.n.)5Y.-----.-Caty�6 ---------4!�-D...;-------- ------------------------------------ Phone--------------------_------ ------ Address � � ------------- 1 --/� .L11.N � Contractor's Name F ------ ----------------------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial [$`Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths Lot size . ------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _______- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PZI_ Hardpan ❑ Previous Application Made: Yes ❑ Nojg-- New Construction: Yes EL_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ante from nearest well-______________.Distance from foundation--------------------Material-----------------------------------------_______. ❑ of compartments----- -------- -----------Size---•----------•-----------------Liquid depth--------------------------Capacity--•-------------- Disposal Field: Distance from nearest w l__-141rh ._Distance from foundation_____0" __' __.Distance to nearest lot line�,�4_�-. �. Number of lines______________ i1-------Length of each line... Q_Q___ _...`_`_-.Width of trench_____ ---------------- Type of filter material-___-( ____. / Depth of filter material......I.g'---------Total length____-_--___ 4010............. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__________-_______..Lining material-------------------------------------- ❑ Size: Diameter-------------------------------------Depth--------------------------_-- ------ --------Liquid Capacity...-------------------_---gal 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, Stat , nd rules and regulations of the San Joaquin Local Health District. Si ned n- --------------------------------- __Owner and/or Contractor By ---- ---------------------------------(Title)------- (Plot plan, showing size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------- --------------------- --------------------- ------------------------------------------- DATE--------------------•- REVIEWEDBY---------------------------------- --------- ---- -------------------------------- -------------------------------- DATE--- --------• 0 -••------------•-----•-•.---------- BUILDING PERMIT ISSUED----------------- ' - --------------------------------------------------------------- DATE Alterations and/or recommendations:----- -------- --------------------------------------------------------------------------- LQ-----------------•------------------•------------- ---------------------------••----._._..._...-------------•-------------.._..-- .................................----••--•--•------------------•--.._....-----•------....------------•-•---------------•---------------_.. ------------------------- ------------------------------------- ---------------------------------------------- ---------- --------•--------•---------•----•---------------------------------------....... ---------------------------------------------- ------------------------------------ -------------------------- --------- --------------- ------------------------------------------------------------------------- y SFINAL INSPECTION BY:-- -----LY`----t'------------- --------------- -- ---- 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 12-54