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o 1 APPLICATION FOR SANITATION PERMIT Permit No. �7..��.. (Complete in Duplicatef j Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereRrr4escribed. This application is made in compliance with County Ordinance N49. , JOB ADDRESS AND LOCATION 30- ....-----------------;:Z ....... ... . Owner's Name---J.. .... .�4'. ---- = ---- ------ ------ Phone------------------------------------ Address-------- , ------- ! _ Contractor's Name...............................................................................................................................----------••-- Phone................................... Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms _1 _Number of baths --._ Lot size ...t .C�.X._._.._(__74.................... Water Supply: Public system ❑ Community system ❑ Private JA Depth to Water Table7'gft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,N Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No g New Construction: Yes ❑ No ❑ 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----�0------Distance from fouoation----/v..........Material------Ir.�,& ;.. ............. (� No. of compartments--._-____- ----------Size.-?.)( ......Liquid depth--------� .----__-..Capacity_..._ t fl'..... Disposal Field: Distance from nearest well__b----Distance from foundatio Distance to nearest lot line...... 91 Number of lines----- Length of each line./f_1-. e:....Width of trench..../._- ;---------------- Type of filter material---�. -...-._-_- -_Depth of filter material------11�._.------Total length---------46` ........................ Seepage Pit: Distance to nearest well.......................Distance from foundation....................Distance to nearest lot line __..,___-_. ❑ Number of pits__ _---------Lining material------------------------Size: Diameter--------------------_-_^6eptn------------ ._-___._-----_.-._ Cesspool: Distance from nearest well ................Distance from foundation-.------------------ material-----------------..................... ❑ Size: Diameter--------------------------------------Depth---------------------------- -------------Liquid Capacity............................gals. p Privy: Distance from nearest well---------------------------------- --------------Distance from nearest building__.--.--_.--._.._.----_---•--.-----.----- \l ❑ 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. (Signed)..**.7_''4 -er ..-. - -_.- .----..___.-.---(Owner and/or Contractor) By:...................................................................................... --------------------------------------------(Title)--------------------------------------------------------------•- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Okq_Nr;� TNT U ONLY APPLICATION ACCEPTED BY---- TE------ J.. .- .. REVIEWEDBY----------------------------- --------------------------- DATE----------_--------_----------------- --------------- BUILDINGPERMIT ISSUED.................................. ------------------------------------------------------------------ DATE----- .............. Alterations and/or recommendations--------- ---------------------------------------------------_................................................................. ---•------------------------•------------------------------------------------- --------------------------..................................................................................................................... -------------------------------•-------......-------------•-------...------------------------.......------------------------•---------------------------------------------••------------•-------------•------•-------------- .i FINAL INSPECTION BY: '---- ------------ Date....--- �/ I 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 .-9-2M 145446 ATWOOD 12-54