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APPLICATION FOR SANITATION PERMIT Permit No. _1..._..__.- (Complete in Duplicate) O Qa� Issued �h� IZf —t(v 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-.- ----- FeR O f X7-4-D-3-----Vi-AP6-i-L `5 7.7 Owner's Name------ --_A------------ ------------------------------------------------ _ ------------------------------------------ Phone------------------------------------ Address �jfd , ..... f ' L 6 Contractor's Name----- -1 ----- S- ------- r� �f'-' Phone----------------------------------- Installation will serve: Residence �partment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . Number of bedrooms _Number of baths __ -_ Lot size ____ _____ ____ d-------------- Water __ _________Water Supply: Public system ❑ Community system ❑ Private EP—Npth to Water Table _5_d ft. Character of soil to a depth of 3 fee • Sand ❑ Gravel ❑ "Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ez]--Hardpan ❑ Previous Application Made: Yes g No -New Construction: Yes P4__le-❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tagk: Distance from [ � nearest wel ___ - _____... -__"_ Distance from foundation.__ 0Matefial-_`-_-r- ------------------ ___8?!-L -------------- No. " """ No. of compartments__ . _.__._ -- _Liquid depth----- ' ----- Capacity---� �-4---- -- Disposai eld: Distance from nearest well-_wd_`.__Distance.1 from foundation_ ✓c3"Q- -"_"".Distance to nearest lot line��._�_ _ WNumber of lines---.------- ---- - *,--------Length of each line_____ _,7_.d._-_ -/- ------Width of french-------�f------------ - JI Type of filter material-___ ._ ...:5_ t'_Depth of filter material----1B----.__.__.Total length----_-___------------------------------ / r f Seepag rt: Distance to nearest welL_I�Q-----------Distance from foundation"-�6_______.__.Distance to nearest lot line__.______ Number of pits-------/------------Lining material,gr-i C 4-_-._Size: Diameter.__-03.".._".__..Depth_____. ` a"__ - ------- Cesspool: Distance from nearest well________________Distance from foundation........-_.------- Lining material-___..__.--------------------_-_-- El Size: Diameter.---------------- -------------------Depth - ---- --------------------------------------------Liuid Capacity --------gals. Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line---------------------------------------------------------------------------- - Remodeling and/or repairing (describe):_-l- --_ . ---------- _- . - -- ---M-------------------------- •- - -- -----------------------------------------------------------------------•-------------------------------------------•------- -----------------------------------------------------------------"•-----------•-•-•------------------•...........---------------------------•------------------ --------------------------•-----•---------• -------- ------------------------------------------ --------------------------•-••-----------•------------------------•----------------------------•--••-•-----•--•-- --------------------------• --------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- 1`s --- ------ ------ O er and/or Contractor) By:......... _. . -- -•---•-- --- - - ----•-------------------------------(Title) Ad - ------------------------------------------ (Plot plan, showing size of lot, oca ion of system in relation to wells, buildings, etc., can be plareverse side). '.nn FOR DEPARTMENT USE ONLY U APPLICATION ACCEPTED BY__�.A --- B'N! S - ------- DATE-------------= REVIEWED BY ---- --- ------------------------------------------------- ----•-------------------- DATE BUILDINGPERMIT ISSUED.---:-------•----------------------------------------------•-----------•---•••----------------------- DATE------------------------------------------- Alterations and/or recommendations:-- --- ------ --------------------- ------•---•--------------------------------•------------------ ------------------------------------------------ ---------------------------------------------------- --- - - - - ------------- - I...--..��!-- e----- ----------------------- ---------- ---------------------- ---------- --------------------------------------------------------- FINAL INSPECTION BY:--- -- ---�--------------------------------- Date"----_-_)-_..-`--�.--1---��- ---------------- ------------- 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 ES-9 145446 ATWOOD