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APPLICATION 1 . A SANITATION PERMIT Permit No. ._1_ - -_ (Complete in Duplicate) Date Issued ____.--- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to constr ct•,.nd install;th414�r herein described This application is made in compliance with County Ordinance No. 549. _ ��y, , JOB ADDRESS AND LOCATION.-,.___. 7..-----.1------•- Owner's Name---a-Z 1 -------------•------------------------- ------- -------------------------------- Address..... -------------------------------Address..--- .... u - Contractor's Name... --------------------- Phone zv _ Ins+allaNumber ofrlein Residence Number bedFrooms .___ ._CNumberlof.baths :er Court ❑ Mote] ❑ Other ❑ Apartment ❑ ❑ Trail g ! Lot size ------------F-=Z-2-6 -P---------------- ----------- Water Supply: Public system ❑ Community system ❑ Private 10 Depth,to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Claly Loam ❑ Clay ❑ Adobe Ej Hardpan ❑ Previous Application Made: Yes ❑ No New Construction-. Yes IR� No o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--;______________Distance from foundation______________ Material-----------------------.-_.______-_--..______-. o. of compartments------ ------ --- ----Size--------------------------------Liquid depth---------- - --- ------._Capacity------ --- •----------- Disposal Distance from nearest well____- - ...,Distance from foundation--------------------Distance to nearest lot line----------------- 6x_e� C/ Number of lines---------------------= --------Length of each line-----------------------.------.Width of trench----------------------------- ----- Type of filter material---- _-..I_____________Depth of filter material--------._.-_-------_Total length------------------------------------------ — -.4 ► Seepage Pit: Distance to nearest well:. _`0..._...Distance from fo ndation_____. Distance to nearest lot line--- � Number of pits________ _______±____Lining material---Z _ Size: Diameter____:5X�.......Depth____ �- \ Cesspool: Distance from i 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 ------------------+----- 4 Remodeling and/or repairing (describe)-------------- ----- .... -r----- ._....-- --------------------------------------••----I--•-----•-----------------------•-------------•------------------------------------•-------------------------------------------------------------------------------------------- - ------------------------------I -----------------•------------------------------------------------------------------------ ••---..-..----•------------------------•------------------••------- ---------•--------------- I hereby certify tha+ I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------- ----- --------- {Owner and/or Contractor)(Si (Signed) Q By: � - --------- -----------------------------------------(Title)---------,sem s--- . �I------------- , (Plot pian, showin size of�l ocation of sys+em in relation to'wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------- -------___------------------------- DATE-�----...--------------------------------•--------------- REVIEWED BY---------- --- . -- ---- BUILDINGPERMIT ISSUED--------------- ----------- ------------------------- ---•------------ --------------------------- DATE--- -------------------------•--------------------- _ Alterations and/or reco.rmmendations-------------- --F----------------------------------------------------.--------------- --------------- �..-.. f - ------ --- -� 3 i ----- / ------- f - --- -------- ---- ---- -- - -- --------- FINAL INSPECTI BY--------- -- -- ------- - -------- --------------- _T f 4 [-�2 Ui LT T7 130 South American Street 300 esW t Oak Street I Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E S-9 145446 ATWOOD