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a- APPLICATION FOR SANITATION PERMIT Permit No. _________________ (Complete in Duplicate) Date Issued -."�___`-_5_.__- 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. 5449. �y JOB ADDRESS AND LOCATION fP �?_,��'-.)?X/� _.../6/_I ------------------------------------- --•----------- -------------- Owner's Name---------- en_5r1 fje�----------- ------------------------------ ------ ---- ------ Phone------------------------------------ Address-------------------------- Contractor's Name--------_-------------------XP,�--- '- = 'y e_-.Keg-0- Phone----------------------------------- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms __PZ__ Number of baths .f.-. Lot size ___e _f__ '____.�. ____________ Water Supply: Public system "Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No JEr" New Construction: Yes ❑ No �--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nk: Distance from nearest well_. X_Distance f om foundation___-40--------Material___(__ .___ No, of compartments___....Q..............Size-_ -_?(._ ____Liquid depe4 If th_._. .Z---__--------Capacity---e"_644 isposal Field: Distance from nearest well_A47ZA Distance from founclation_./ __....Distance to nearest lot line.__x_!-__- Number of lines-______- ______ ___- Length of each line-_____ ...............� - ---------- - g �--- - -Width of trench__,?*-",------------------- Type ---------------- Type of filter material__ _,��.4.0. .Depth of filter material----f�_.______._Total length_-_._e1_iO_ _________________________ Seepage Pit: Distance to nearest well._AVO.----Distance from fou dation___,_?40-....___ Distance to nearest lot line_ . Number of pits._._f___.______._Lining mat erial_40E`_Al-AM - . Diameter._-3"______..____Depth_____Q-0 ------------------ 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 (describe):-------------I-ta-1j3_ -__fit _ _E'�2Z-'--------------- \ -----•------------------•---------------------•--••----------••--------------------------------------------------------------•-•-•-.._. •------------------------•----------------- _------ ---------------------------•------------------.------------------------.•-------------------------------------------------...-------•----------------------------------------------------------------------------------------- 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. 4 f -------------------(�r Contractor) {Signed)---•----••-•----------��-�---=- � �- Eq��•;---- -�a-�'�--Y--�------------ - - - - -- •- -- B ± � Title app Y� ) - --------------- (Plot plan, showing size of lot, scion of system in relation fo wells, buildings, etc., can be placed on revers wide). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED B --------------------- - - -------- ---- --- ---------------------------------------- DATE—--------------------------------------------------- REVIEWED BY----------------------------- ��---------------------- DATEA- ---------- ., BUILDING PERMIT ISSUED---------- - ---- ------ -------•-------------------------------------- DATE.-_. - Alterations and/or recommendations:---------------------------------------------------------------------•---------------------------------9`----------- ------------------------- -------- -----•----•----•- •----•-------•-- ----------•----------•------------------------- �------ --- -- ------------------------------------------------------------- ------------------------------------------------- ----------------------------------- ---------------------- •-----.•----------- FINAL INSPECTION BY:,---- -_G -------------------------------- Date--------) . --- --- r -- -- ------------------------------------- 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 EEr9 145446 ATWOOD