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APPLICATION FOR SANITATION PERMIT Permit No. ."".-�.-1..--�r---1--- (Complete in Duplicate) Date Issued ---�/ _(o Applica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. p �`- _- This application� is made in compliance with County Ordinance No. 549. JOB AdDRESS AND LOCATION___-L�r�r-- - Pkon ,q --------------------- --•--- ,0 OAddcess.---ame"-: �:"r.._�dy...""��__y---------nzy"�___�_.----�--�----- Phone----------------------------------- Contractor's hone----------------------------------- Contractor's Name_,7-0:Ind------------------------------- ----- Mate! Other ❑ Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ �el ❑ a A Number of living units: _--j"__- Number of bedrooms ---_ " Number of baths "_'�-- Lot size ---.-_(_.�"._ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ft- Gravel Sand Loam ❑ Clay Loam K Clay ❑ Adobe ❑ Hardp�❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ y i Previous Application Made: Yes ❑ No 5Q New Construction. Yes 5d No ❑ k 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---7 -----Distance from foundation_------ -- ---- •---- ---------------.Matenai".-"-_"_"""_._-""_- No. of compartments-. ^.- Size-- Liquid depth---�------- -------- Capac,ty.� �' Disposal Field: Distance from nearest well-" 90""._.-._Distance from foundation"' � Distance to nearest lot line.- Width of trench__-d- --------- � Number of lines--_4------ /- -------------- --Length of each line---.7 °" ti� % -"Depth of filter material_."l_�------------Total length___- -----•-----• Type of filter material_-/"1`"-/ -- ' arest lot line Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------."_..Distance to ne171 _._"""_ """"_"_ Number of pits----------------------Lining material-------------- -------.Size: Diameter-- ----------- --------Depth--------------- ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----__-------------Lining material-----"_--_-------------------------- Liquid Capacity gals. Size: Diameter- --- ----- -------- -------- -----:Depth----�-------- -------------- --- -................ q P Y EDistance from nearest building-_--------------------------------------- Privy: Distance from nearest well---------------------- - - - - - - - ❑ Distance to nearest lot line----------------- ------- ---------- --------- ----"""--- - ---.----•---- -------------- ------------- Remodeling and/or repairing (describe):----------- ------- -- -------------------------------••-- - ------------------------------- •----------------------------------------------------------- -------------•-------- I hereby cef--y that I have preps ed this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, an9rules�and egulations of the San Joaquin Local Health District. n (Owner and/or Contractor) Si ned ( 9 ) CV1, z. • I •-------- ----------------------- F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,p FOR DEPARTMENT USE ONLY f '� f! -�--- - DATE--- "'r ' "�c�'--------------------------- APPLICATION ACCEPTED BY.-- i ------------------------------ DATE--------------------------------------------- --- REVIEWED BY DATE------- --------•--- BUILDINGPERMIT ISSUED----------------------------------------------------------------- Alterations and/or recommendations:."_"_---_-.""- ..-_..-------------- -----------------------------------------------•--------------------------------•---- ----- •----- ------------ --------- - - - ------------------------- i ------ ----- Date-----/--.- i FINAL INSPECTION BY ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California 1 Stockton, California Lodi, California Maritime, California Y E:S-9 145446 ATWOOD _