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! I� APPLICATION FOR SANITATION PERMIT Permit No. 3 ' (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 Or nan e No. 549. ryry l I JOB ADDRESS AND LOCATION__ ------------------------------------------------------- Owner's Name..._` � .�. f .. ---------------------------- ------ Phone.-------------------•--•------------ ' I -----------Address -------..... --/-- � ------------------------------------------------------------------------------------- Contractor's Name------• , � �` / / r�-cam'--•-••--------- Phone----------------------------------- I Installation will serve: Residence [+Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j 's Number of living units: _/-___ Number of bedrooms ._�___ Number of baths _1___ Lot sizezC_�.�_ _______________________ Water Supply: Public system n Community system ❑ Private R �- epth to Water,Table 4_9_`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �iay,L a ❑ Clay ❑ Adobe ❑ Hardpan ❑ l Previous Application Made: Yes ❑ No [ New Construction:`.Yes E] 'N6' f TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3 Sep!t Tank: Distance from nearest well-----------------Distance'from foundation--------------------Material------------------------------------------------- No. of compartments Size--------------------- --- -----Liquid depth--------------- - --------Capacity----------------------- 4049 Disposal Field: Distance from nearest well__.-_-....._Distance from found atio ___ __ .______rDistance to nearest lot Eine__f______________ Number of lines_______.2------------- ----- -Length of each line_ .--J ---.Width of trench.--•-- -- -`---------------- Type or filter material/-r—A—e --Diepf h of filter material__X ___-_-_ f � �� ------Total length-----�- `--r---------------•--�- Seepage Pit: Distance to nearest well-_____________________Distance from foundation--------.-----------Distance to nearest lot line_______.____._-__ ❑ Number of pits----------------------Lining material__:--------------------Size:;Diameter-----------------------Depth-_------------------------------- f� Cesspool: Distance from nearest well--.--------------Distance from foundation...._-_---___.:__..Lining material------------------------------------- ❑ Size: Diameter- - -------------------------- ------Depth ._Y---------------�= --------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------______---------!-----y---- ---- .-Distance from nearest building------------------------------------------ ❑ Disfiance to nearest lot Ione-.. rJ - -� _ - ------ Remodeling and/or repairing (descr'sbel:__-___-__._�_._.- _�---------------- 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)------------- :.. ' ^Z !Cry `'" rf 1 ��P� -'--`°�` �- ---(Ori **dAor Contractor) By:--------------------------- (Title)---------- , / fa.�c Vii,1 (Plot plan, showing size of lot, lo_f tion of system in relation to wells, buildings, etc., can be placed on reverse`side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- - -- ---- ---------------- - ---- -- ---------------------------------------------------------- DATE------------------- -------------------------- -- REVIEWEDBY-------------------------------- ---------- -=-- ---------------------------------------------------------------- DATE------ __ -/----------------------------------------- BUILDINGPERMIT ISSUER---------------- ----- -4-- ----------------- --------- --------------------------- DATE---- ------------------------------------------------ Alterations and/or recommendations:. ` ----------------- ---------------------------------------••-------------------------------.--------------- -----------------------------------•----------------•------------ --------------------------------- ---------- --------------------------••------------------------------ -- -------------------------=---------------------------------------------------------------------------------------------- ---------------------------- ,. �_ Date..l l..�L�_ .( 6 -----•----------------------------=--------- FINAL INSPECTION BY:_../C..:.`.r(_--=---�_�_-----'�--------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATWOOP