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41- APPLICATION FOR SANITATION PERMIT Permit No. ____7h.. -- (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 LOCATION---- 3 ---'--D2CJ__l ---------------- Owner's Name----------------------------��V-tqq-r�r -------- .-� R =- - ------------------------------- --------- Phone-----.-_..-..----------------------. Address-----------------------------------------------------t.Ct,�_G.._-...0 k-� - Contractor's Name------------------------------------------ ••-•----- ' -----•----'---------'------------------------------- ------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ ; z Number of living units: __/-___ Number of bedrooms _- Number of baths I--- Lot size -______---��x-X�:�--------- Water Supply: Public system X, Community system El Private ❑ Depth to Water Table _ '- ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No K_ New Construction: Yes ❑ No 1�r 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__.10--_------.Material _______.. _{�_ •'l , No. of compartments_-._._ ______________Size___ _ __/-------- -� -Liquid depth----------4-----------Capacity------ Disposal Field: Distance from nearest well....�--_-.Distance from foundation-----ld------Distance to nearest lot line___-_v�___ Number of lines------------ Length of each line------------ 6'Ca----------Width of trench---------------Z`f___---_-- ----- ------ Type of filter material____ -_Depth of filter material__--_-_.-12__.._Total length______--__________`-2-0------------- 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-- :"T!�----------gals. Privy- Distance from nearest well------ ------------------------------------------Distance from nearest building__-----__.___.____---___________.____.._. (� ❑ Distance to nearest lot line--------------------------------------------------------------------------- ------------------------------------------•----------------------- W Remodeling and/or repairing (describe):---------------------- -------------- -- -----------•------------------------•-------------••----- -•--------------------------------------------------• --------------------------------------------- -------------------•--------------------------•-----------.----------------------------------•----•-------------------------------•------...---------------------------------- ----------------------------------------------------•--------•----------------------------------------------------------------------------------------------------------------------•------------------------ -------- - -- I hereby certify that I have prepared this application and that +he 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} , =-------------- ----- -'--(Owner and/or Contractor) Y� ►rl x.? .R�__._ _1 :-.�.R _ ----------------------------------(Ti+le)---------------------------------------------' (Plot plan, showing size of lot, location of system in relation to wel uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - ------------------------------------------- DATE---------- 1 REVIEWEDBY------'------------------ -- ----'- - ---'---- -----'-'-------- ---------------------•------ - •-- --------- DATE----------- ----- BUILDING PERMIT ISSUED ------------------------------------------------- ---------•--------------- ------------- DATE Alterations and/or recomm ndations ' ' - --------- --- ------------------------ -----------•-----.....------------•------------•------------------- ----------------------------•---------------------------------- ' ----------------- :_ ----- ------ ---------------- / 5 � FINAL IN TION BY:----' '- - -- --- ------'---------------'-'------------ Date._.-f--�J_.7.------'------------------------------------------------------------------------- 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 E5---21YI 145446 ATWOOD 12.54