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APPLICATION FOR SANITATION PERMIT Permit No. __.-i ?� (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 Ordin e No. 549. JOB ADDRESS AND LOCATION----- � Q ►__ _ Q.�— --fel .. --o � �� a Owner's Name E 1___ one -•------------- Address..........1_f .............. ' Contractor's Name_ _��. : L - - i t- C-c � ~-----•---••----------------------- Phone-,eo�e-�1� Installation will serve: Residence ❑ Apartment House ❑ Commercial,� Trailer. Court E] Motel [-] E]f,, Other Number of living units: -------- Number of bedrooms -------- Number of baths ._ Lot size ____ Water Supply: Public system U—Community system ❑ Private ❑ Depth to Water Table _4- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pll%,Hardpan ❑\�y Previous Application Made: Yes 0 No� New Construction: Yes R5. No E] Vl TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 Septic Tank: Distance from nearest.well__/Ildh4r•Distanc rom foundation__--64--t____-Material-__ - -- r . __�_7-_---_-_-- No. of compartments______ _____________Size__ _�__ _60Li uid depth______fp( _� ------Capacity /�� - \ Disposal Field: Distance from nearest well.-/. from foundation---dZ.S-------Distance to nearest lot line___) d_ _ ' Number of lines____________ ____ -._-_-_-__Length of each line-_.___. _ -_--:.__._.Width of french---------- ----------------- , Type of filter material...1�.._..__ 1�epth of filter materiaL____r,Y-"__._.Total length------ 5 ______________________ Seepage Pit: Distance to nearest well-____________________Distance from foundation_________.-:-_.---.Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------- material----------------- ❑ Size: Diameter------ ------------------------------ Depth------------------------------------------- --------Liquid Capacity-.:.------------------------gals. Privy: Distance from nearest well_____.__..__'___________________________________Distance from nearest building_____.___._____________-..._-__-__,__._. ❑ Distance to nearest lot line-------- --------------------------------------- Remodeling ---------------------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)-------- - •: ---- _--------------(Owner and/or Contractor) By:.- ft. r2 --------------- ----(Title)---- .:------------- --------------------- (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----------------------- REVIEWED BY. DATE---297---•---------------------------•--- BUILDING PERMIT ISSUED.............. ------------------------ DATE--- Alterati ns and/or r commendations:__.... .............. .........' _ _--_-_ __... ------ �' �-e -- ---•--------------------------------------------------------------- FINAL INSPECTION BY-------------- -- Date---....lliz _- .----------------------------- 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 145496 ATWOUD 12-54