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APPLICATION-FOR SANITATION PERMIT Permit No. (Complete in Duplicate) - Date Issued l Cos-!�f-z-cS Applica+ion is hereby made to the San Joaquin Local Health District for a permit to constFuct and install the work herein described. This application is made in compliance with County Ordinance, No. 549. J B ADDRESS AND LOCAT! N 1 _,_ :h Gft! t-�Lc'z�F..t' � L' .'� � -- Owner's ----------------------- -- --- Phone •-------------- ,� -----•----------- { Contractor's Name..._-i �"' -----•< ` ----------------------------- Phone--_-.-.---••---=_----•-••-•------ i ---- Installation will serve: Residence &/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other�jj Number of living units: __ --_.Number of bedrooms _k.- Number of baths __1___ Lot size ___ _x.--/_ZQ____._____ Water Supply: Public system Community system ❑ _ Private ❑ Depth to Water Table ._.____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam El- Clay E] Adobe [/Hardpan-B_- Previous Application Made: Yes E] No E New Construction: Yes ;/t ❑ TYPE'OF INSTALLATION AND SPECIFICATIONS: t ~� (No septic tank or cesspool permitted if public s.war is available within 200 feeta) r6` Septic Tank: Disfence from nearest well _4`�Dista e fr m foundation _ M teriaL_._____;__.__.__. _ ----------- ( No.gof compartmentsd__....ISize_ �^41 Liquid e fh --Capacity O D - , qp pisposa field: Distance from nearest wellDistance from foundation_� ��' Distance to nearest lot lin + [ f eQ 1 i.(---• Number of lines____________ ____ _,_Length of each line__-.______...._.._ Width of trench._____._+ �"" Type of filter, materia_ ._ r ' epth of filter material------ Total length_-----------�_0---_-----I___-•-. - See�pa a Pit: Distance #o nearest well... __ ---�------Distanc� {ro foundationlO_*Dis#ante to nearest lot line._ LJ Number of pits-------- -I--- 9 {;,� `444*_—S- r� -' r� X� !.........Linin material ' ¢e: Diameter °, Depth_ ------------ Cesspool: Distance.from nearest well-----------------Distance from foundation-------------------- material__.__-_-__..___.---_______________._ ❑ Size: Diameter------------------ -------------------Depth ------------------------------- ----._Liquid Capacity--------------- - -- --------.gals. Privy: Distance from:nearest well .................._____._.____-..__---_____--.-Distance from nearest building----------.-----------_---------- ------- El' Distance to nearest lot line.... --------- x-------------- --------------------------- Remodeling and/or repairing (describe) ----- - ----------------------------•-----------•----------- = SI -----•-•-------------------•-----------•------------------------- -----------•--------- ----------------------- ----------------------------------------------_--•-_ ------ ------------------------- ----------- ------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------- I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and regulations of the San Joaquin-Local Health District. (Signed) t y �1 ------------------------------------------ (Owner and/or Contractor) BY:----- - -- ----- - ---- ----------------------- --- ---(Ti+lel ----------------- (Plot plane wing size of lot, location of system in.relation to wells,,buildings etc., can be placed on reverse side). "1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�. I--------------------------------------------------------- DATE.--I------•---•---- REVIEWED BY------------------------------ -t- DATE-» - ------ ------------------------------ - ... BUILDING PERMIT. ISSUED -ZJ-'----- -- -. --------------------------------- ---------------------• DATE------- U Altera+ions and/or recommendations: KN -----------------------•---------------------------------------------------.--------------------------------•- -•------ '------------------------- 0-_-J-------------- tom, ----------------------------------------------- ----------------------- - --------------------------- ------------------------------------ _ T - FINAL INSPECTION BY:...........:. .--n ti./ `'"`_` Da+e ` p / 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E+--3 145446 ATWOOD