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S APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) G Date Issued Applicaf-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 LOCATION___-_oo --� ------------------------- ---------------------------- ------- Owner's Name-------. .___'..______•-i_ •- –, 21 Address--------------- ----------------------------•-••---------------------------------------•-------------------------------------- Contractor's Name_______-.------------_"--_ ----- -• I Installation will serve: Residence [Apartment House ❑ Commercialiler Court ❑ Tra` ❑ Motel E] Other E]Number of living units: _-! Number of bedrooms _,2—. Number of baths ----(_ Lot size -----••------•-----•--------- Water Supply: Public system E�Community system E-1 , Private ❑ _ Depth to Water Table 3_ _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LA—Hardpan-E] Previous Application Made: Yes ❑ No [2F--New Construction: Yes 21-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r � (No septic tank or cesspool permitted if,public sewer 's available within 200 feet.) Septic Tank: Distance from nearest -- - ---_ _ - rfl;i7s�fance from ounaon. Q- _.p_._..__.Materia_-l-_---_- --- No. of compartments------Zt - ------------ d _-Yw. C - ---- pa -- Q-a__-__--- Disposal Field: Distance from nearest well.�F!_O---- Distance from foundation--Ag? --._ __.Distance to nearest lot line----------- _�___ _-- * ' Number of lines----- ---------------- Length of each line--- d._.7_3-0 -.-.Width of french ------------ Type of filter material__------Depth of filter mate ria l_1�-".-_-------Total length------- -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______-.______.._ ❑ Number of pits----------------------Lining material-------------- --------Size: Diameter-------------- ---------Depth---------- ------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material -..___-__.__-_.._._-_ \ --------------- ❑ Size: Diameter----- --------------------------------Depth---------------------------- ----------:_--------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- - _-_-__-__.._Distance from nearest building ❑ Distance to nearest lot'line-- --- ---------------- ---- Remodeling and/or repairing(descr;be):___----- " ----. --•---------•------••--•------••-----•--------• ------------------- ------------------- _,,_4---7------ ----------------------------------------- --------- -----------------------------------------------------••-------------•-----------------------------•-------••------------------------------------------•-----•----------------------•------------------ 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:........-----------•-----------•------------ - Title of 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---_�7 /, __-:--- REVIEWED BY � ------- DATE---- ----•. --- - ---•---••-------•----•-----•-- BUILDING PERMIT ISSUED -- ------- ------------------------------- ----------- DATE--------- ---------- Alterations and/or recommendations;----------_----_--- ------------------------ -------------------------------------------- - --------------------------- - -------------- --------- FINAL INSPECTION 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-ZM 145496 ATWOOD 12-54