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APPLICATION FOR SANITATION PERMIT Permit No. -----7.d (Complete in Duplicate) // Date Issued ----- /W�& I h 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 CATION-- vl S L D �l Owner's Name------------ 0------------------------r,�, r - ✓-------- ----- ------------------------------------------------------- Phone-------------------- �Address.......... -- ------•-- -------- ------------------------------------------- f •-...----•- -•--••--•--------- -----------•- Contractor's Name Phone---- •------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ? ' Number of living units: �_ Number of bedrooms ___a2_ Number of baths 4---- Lot size ------ -._x-4!?z _-------- Water Supply: Publics stem 'Community system Private Depth to Water Table (p& k(f U PP Y� Y ��- Y Y ❑ ❑ P .�_ ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [] Previous Application Made: Yes ❑s No ZL 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-_,M149--Distance from foundation_--_.4,157-4___.Material-_ 1� No. of com artmenis........�_____________Size__j,-X1�..__ ____Liquid de th_______do __-------Ca acit 4Aj0 Disposal Field: Distance from nearest well_ "__Distance from foundation___,V__7..... Distance to nearest lot line._,f�_o____ LN Number of lines -------- __- 11 ----- Length of each line____3• --_-. Width of trench..____.:_ Type of filter material.l .--__�. Depthi____ of filter material _-_._f,_-_--_-__-Total length-------�.6`--_-------------••-- oq See{{paage .Pit: Distance to nea 4 st well__.- -�-Distance fro foyndation=,_��_.Dista cue/to nearest lot iine__.�� / 0 1 !C '' / --- Number of pits-_}.__/_________-_Lining materialL� __ _.-_-_� Ize: Diameter____�� __._.--_De_-Depth 15 f -• Cesspool: Distance from nearest well----------------- from foundatio`n._.-_.___-_________.Lining 'material------------------------- v' ___-_.-_-.--_ T ❑ Size: Diameter- =-- - ------------------------------Depth----=--------- -----------"----------------------Liquid Capacity- --------------------------gals. r�;rte Privy: Distance from nearest well___---------------------------------- ____________Distance from nearest building-------------------------------- ❑ Distance to nearest lot line----------------- --- -------------------------••-------------------- =--------------- Remodeling and/or repairing (describe)------------------------------------- -------------------------------------• --•-----•------------------ - ------------------------------- --• t ------------•-------- -------------•-----------------------•---------------------•-------------------•----•----------------------------------•------•----------•---------•------- ------------------------------------------•----------------- ----------••-------•---------------••-------•------------------•------------------- -----------•-----------•--------------------------------------••----------- --------- ------------------- --------------------••------#---•--------••------------------------ I 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. S� ned �" ••�� � 9 }--------- ------- ----- - - - - - - - - --------- ------ ---------------- ---------------------------------------.(Owner and/or Contractor) By:._4--- • {Title} ------ (Plot plan, showing size o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-...----- I /` DATE----------- �.. 1 1f REVIEWED BY------------------------------ ----------------------------------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------- ...•-- DATE Alterations and/or recommendations:------- -- -•------ ----------------------------------------------------------------------------------------••-•------- =1 ------------------ - ys�----- -------------------------- ----- - , . ------ ------ --------- - ----- - -- F1NAL INSPECTION BY:. ----- le i �p Date -5�------------------ -- ' , 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 f ES-9-•-•2M 145446 ATWOOD 12-54 r t.�