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j q l� S b ` APPLICATION FOR SANITATION PERMIT Permit No. -----7°_,314.--- (Complete in Duplicate) t 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. JOB ADDRESS AND LOCATION-�------ �-3_1 -. .- Owner's Name__ --- ------------------ -------------------- Phone. Address--------Sa. ` ------ ----Contractor's Name Name-----__ -•- Installation will serve: Residence 5� Apartment House ❑ , Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_ Number of bedrooms._ Number of baths . Lot size _--_--- s�--�-----�--�---...- •-------------- Water Supply: Publics stem ` _ r pPY� Y Community system ❑ Private ❑ Depth to Water Table .Jeff. Character of soil to a depth of 3 feet: -. Sand ❑, Gravel ❑ Sand Loam Clay Loam Clay p ❑ 1 ' Y ❑ Y ❑ y ❑ Adobe Hardpan � Previous Application Made: Yes E❑ No IR_ New Const'rtionn: Yes ❑ No U1, [ TION AND SPECIFICATIONS TYPE OF INSTALLA : ¢ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest wefi___WC7,e_Distance from foundation--.,°2d--t _.Material_-.Li _ c No.,of compartments------c-......-•- --- Size__ _ Capacity -�>�--.�-�.�•_--Liquid depth-------�-8_�r_1- . p Field: Distance from nearest well_�A-4 distance from foundation---__14-_-_--_.Distance tot nearest lot line_f_.� Disposal Number of lines-�_.______�:-._ __/r._- Length of each line_-_-_____ _cy'_____ Width of french �_--__ �� -----••------ Ty:pe of filter material-_/ .�R , Depth of filter material...... -- 1 w -- "-..To+al �length_`--.:.��F-- --------- -=----------- - Seepage Pit: Distance to nearest weif...A/ _ - t .'# o ' d7-�.L�-Distance from f u9 ion--...1 Distance to nearest lot line-----„5��_- ® Number of pits.__(-.-�_-.--._-_ _Lining maferial__�_ _ e: Diameter-._..*-_ _---Depth_-..___ - ! V Cesspool: Distance from n Barest well--- -----------{distance from foundation---_----_____----- Lining material----.._------_-------__----_------_-. off' ❑ Size: Diameter------------------------1------- ---Depth-f-------------------------------------------------Liquid Capacity---------•-------------------gals. 9 is N Privy: Distance from nearest well--------------------------------------------------Distance from nearesf builaN ❑ Distance to nearest lot line} ing------------------------------------------ --- ----------------•---------------------------------------------- Remodeling and/or repairing (describe)---------------------- ------------------ -------------•---••------- ------ ------------------------------------------•------------------• -------------------•-------•-- -------•--------------------------------------------------------------- ------------------------------•------.. -----------•------- ------------------------------------- -----------------------------------------------------I' - --------------------------------------:..-------...-------••-------------------...------•--------------------------------------------- - I hereby certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesysffarffe law , and rules and regulations of the San Joaquin Local Health District. (Signed)----- - �---�-----' --- --------�`---- L .. �� I r and/or Contract BY'---------- --•--._ 71.1`7- s /� -- w Cf. _ ------------(Title)---- -- - ----- � Contractor) -------------------------------- 9 (Plot plan, s owinsize 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 REVIEWED BY ------------------- - -- ------ ---- ---------------- -- -- -- - - ------------------ - ------------ --------------- ------------- DATE------ --------- - - t •------ --------------•------- UILDING PERMIT ISSUED - --------------DATE---- -------••----- `- Alterations and/or recommendations------------- ---- ------m-------------------- -5 - --- -- --=- -------- ,� `?-� ------------------------------------------------•-------------- -----• -----•-----•---------- I ------------ ------------------ ----------------------------------------------- FINAL INSPECTION BY: S� ...--------- •----- Date----s,I---------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street r 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California # Lodi, California Manteca, California Tracy, California E5-4-2m F45446 ATWOOD 12-54 y