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� APPLICATION FOR SANITATION PERMIT Permit No/..(2.3-�/-.__ (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 i compliance,with County Ordinance No. 549 �5 11- s r r p 4. <- o--� JOB ADDRESS AND LOCATION: - ----------------------------------- I Owner's Name . Phone--- • � --- -...- , Address---/ �� +� X/gr__ A Contractor's Name �! ---------- Phone .t7 '"• !tel 1 Installation will serve: Residence ❑ Apartment House ❑ Commercial filer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms -------- Number of baths -2-- Lot size __- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 3_�Q ft. z Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobear pan ❑ Previous Application Made: Yes ❑. -No 04 --New Construction: Yes p4>_lo-= TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` P e f4'.'---.Material--- SeptiTank: Distance from nearest w•ell.__70.----_Distance from foundation__-- . [�--- No. of compartments------. .---- Size----��`_ _-1�.�_v_._Liquid depth_.---------------------Capacity _10-- Disposal Field: Distance from nearest well---7.Q-_`____Distance from foundation------ -Q-`-_-.Distance to nearest lot line--e-�.- r r �� Number of lines-----------1-_ __. , Length of each line------�-.�_ ___Width of trench.-..- - r- - : - - - Sr ;�---------- ---------- Type of filter material-__, -- ------------Depth of filter material---- Total length_____679____,_____ j . Seepage Pit: Distance to nearest well__./ _0-------DistanceAom foundation_---/-- -_f.__..Distance to nearest lot line--- AL Number of pits......1--------------Lining material-----__ ----Size: Diameter___IF-----.-.__-Depth--- _-.--.__--__________ Distance Cesspool: tance from nearest well-----------------Distance from foundation-_______----..----- Lining material....-__....-------.---_._----___.._• ❑ Size: Diameter._F. -------- -----.Depth_.--- --.--- Liquid P uid Ca acitY --- af a r ----------- 9 s. Privy: Distance from nearest well--------------- .-..-.-.....____--._-Distance from nearest building------------------------------------------ Fl—. -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, St a laws, and rules and regulatio s of the San Joaquin Local Health District. 6_6(signed) 8w� Contractor) -- ---------- -------- - ------ - or By: � - L------------------------------- (Ti+le) ._.- -- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - --------------- -- ---------------------•-------=---- --••-------------------- DATE REVIEWEDBY------------------------------- -- ----I------ -- ----------------------------------- --------------------------. DATE----J1- -- --------- •---- BUILDING PERMIT ISSUED------------- ----- --- ---- ---------------------------- ---------------------------------- DATE------------------------ --------------- Alterations and/or recommendations:.---------------------- ------. --.t- - -------------- •- --- f ---- f -------------------------------------------------------------- - -- - - - - -- - -- - - -------- -- - - - - ----- -- ----- -_- ------------ FINAL INSPECTION BY: -------------------------- -------I------------ Date-------5.------ ---------------------- 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 rs--.9-2M 145446 ATWOOD 12-54