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'IND, APPLICATION FOR SANITATION PERMIT Permit No. (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, JOBADDRESS AND TION. _ -Cs!_ _� � _.-_.- Owner's Naq�4' �-- Phone------------------------------------ 'fJ ----------- Address. Q�T ��_ -_---... Contractor's --- --- ------------------------------------------------ ----•---•--------------•----------------------- Phone----------------------------------- Installation will serve: Residence A,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms _oA-)_-Number of baths __J_ Lot size _ ____'_12---------------____________'� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: Yes E] NoNew Construction: Yes` No El . 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-A-Q-------Distance from foundation---/-_0----------Material_____________________ `� No, of compartments_.._....------ ----Size__I)C,�,JC'j______.___Liquid depth__--L�-----------------Capacity____ Q-o Disp��o\\sal Field: Distance from nearest wefl_.�Q......Distance from foundation__y,O_ --.---.Distance to nearest lot ------- Number of lines-----------j....______ Length of each line___.7._.S_.__..___ ___-Width of french__J_ ,_�_____.._____. Type of filter material 'C __ _1�,__ NG� filter material_...__/________..Total length___:_' _c5____________________________ r Distance to nearest well _ __ _-__ _ nce from foundation--------------------Distance to nearest lot line------------------ Number of pits----------------------Lining material_----_._-.------------ Size: Diameter-----_-------_---------Dept h.......------------- 14 ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--- . ❑ Size: Diameter De?th ; ------ Z-------------. - - —.,..Liquid Capacity-------•-•------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------------------------- ------------- El __ - __--❑ Distance to nearest lot line-------------------------------------------- - ------ ----------------------------•----------- 'b ------------------------ ---- Remodeling and/or repairing (describe):-t ,� ------- ----------•--------• ••------------ -------------------------------------------------------------------------------------------------------------------------•---. ----..------------------------ ------------------------------ .:...._.------------------------- 0 G 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. w (Signed)--- ' ... . ..---- �". t-----------------------------------------------------------------------------------(Owner and/or Contractor] By:------------------------------------------------------------------------------------------------------------------------------------(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------ ----------- ------ - 45� DATE-------7Z.— REVIEWEDBY_--------•-••----------------- - ------ -------------------------- ------- -•--------•--- DATE--------- ----- BUILDING PERMIT ISSUED------------------------------------- DATE -� Alterations and/or recommendations:---------- ------------------ _- -••-�,�----------------------- ------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------•---•-------------------------------------------------------------------------•--------------------------•- ........._ •-•-------------------------------------------•----------_ •--------------------------------- ------------------ •- ...----------------------------------------------------------------------------- - --•---------------- —' ----- = ---------------------- ---------- FINAL INSPECTION BY. ---------------------------- Date------- .r -x -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A 145445 ATWOOD 12-54 F ,