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-77 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 41 1Wbate Issued Applica;ion is hereby made to the San Joaquin Local Health District for a per fconstruct and install the work herein described. This application is made in compliance with County //Ordinance No. 549, JOB ADDRESS AND LOCATION__ - / � `T - - - ________ --- - ! - -- Owner's Name -�w --••- ------------ ---------._. Phone = Address—------ Contractor's Name...... -------------------------------------------- Phone.. Installation will serve: Residence E�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _------- Number of bedrooms __'2--Number of baths -Z--- Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table dr)ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe; Hardpan C]Previous Application Made: Yes E] No�_New Construction: Yes�No ❑ ► TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic �TTa''n//k: ~ �D_isfiance from nearest well_________________Distance from foundation--------------.___.Material ___________._-_-_.__.._.______..___________.... ❑ `7�. "— hocompartments- Size Liquid depth Capacity Disposal Field: Dis•ante from nearest well_._-____..._____Distance from foundation____________________Distance to nearest lot line____-______--__. ❑ Lnibof lines Length of each line Width of trench ---------------- YPe s filter material-------------------------Depth of filter material-----------------------Total length---_------------------•-----_-- -------=--- Seepage Pit: Distance to nearest well__-!V�'t--Distance from foundation----f ____.Distance�to nearest lot line- ____�_•l__ Number of pits___________________Lining materialsa� _� S eG a ter_-.._,� _----Depth_��; - --------------•--- k Cesspool: Distance from nearest well_________________Distance from foundation------------ -------Lining material__..___________-________.___---___. ❑ Size: Diameter--------------------------------------Depth------------------------------------- ------------ Liquid Capacity----------------- gals. Privy: Distande from nearest well-------------------------------------------------Distance from nearest building-----_----------------.- ------------------ ❑ Distance to nearest Iot line------------------------------------------------•--------------..._._ - -------------------------------------------------------- ------------- Remodeling and/or repairing (describe)--------------------------------------- ----------------------- �f ------------- -----------------------------------------------------••---••-----------------•----------------•-------------------•--------••---------------------------•-------------------•-----------••----------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St awsr and rules and regulations of the San Joaquin Local Health District. (Signe -�' -f3---.� , ---------- ------{Owner and/or Contractor- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - I APPLICATION ACCEPTED BY..-- DATE -�- 1 REVIEWEDBY -------- ------------ ---- -----------=-- --------------------------------------- DATE- • __: BUILDING PERMIT ISSUED-----------•---- --------- ------------- -------------------- DATE ------------------------------- ---------------------- - ------------------------------------ Alterations and/or recommendations:................ - - . -------•---•--•------ -•------------------ ( -" - - • , ---------- ----•-------------- --- ----- - - �------ -----�--� t G-�� .-----•- - ----------------- d ' f FINAL INSPECTION BY:----- ---------------------------- Date..----./-.--._ .��._ ---------------- .�t 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 E.�i—$ 145446 ATWOOD