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9 APPLICATION FOR SANITATION PERMIT Permit No. Date Issued ____._._}� {Complete in Duplicate] ��i.. Applicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.---;2,A ---/�90-b----L N .... Phone-------------------------------- Owner's ------------•------------------Owner s Name------ / --- ----- A •- -- .. Address. �/59-e" ------------ - --------------------------------------- -----------------•-----------•----------------•--------------------------------------- Contractor's Name----- ... ------ • ---------------------- ------ Phone-•----••----•---------------------- Installation will serve: Residence [P--`Xpartment House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other E]� � 1 Number of living units: ___f-- Number of bedrooms ----/_ Number of baths ' Lot size --Jp-�---------x--6_o------------------- Water Supply: Public system system ❑ Private [] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [L}—Hardpan ❑ Previous Application Made: Yes ❑ Noew Construction:k Yes 94--NoY� TYPE OF INSTALLATION AND SPECIFICATIONS: -' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Ta k: DistalO/.nce from nearest welW Distance from foundation--__ -6.-.._. ..Material_____ _ ________ � -' -------. No. of compartments------T[. _. :.--_Size_ Liquid depth---.--4;-............Capacity-------d_Q_------- � r01 Disposal Feld: Distance from nearest well_f>O.aN�_Distance from foundation.--------P--------Distance #o nearest lot line_____._______. Number of lines--------------L -_fir-------- --Length of each line---------- .....Width of trench-_---V - ----------------- Type of filter material-'.i] ----- _R-___Depth of filter material------f .________Total length ___..___d"z __._....______^_____.. Seepage it: Distance to nearest well_AkN' .- Distance from foundation__.__.P_�5_.....__.Distance to nearest lot line---3-__._----_ Lining material__-PJ.T/.� .Size: Diameter__..-3-�_---�----.Depth.-_-----_+�_-�~-..- Number of pits--------1_---- -- -- 4� Cesspool: Distance from nearest well._______________Distance from foundation__--.--------------Lining material-----------------------------------__. N ❑ Size: Diameter----=----------------- -- ------------Depth ---------------_--.----------------- Liquid Capacity gals. _Nc_ Privy: Distance from nearest well---------------------------- ----------------..D;stance from nearest building----------------------•------------------ ..a . - �.�, _� ❑ Distance to nearest lot' line__.---------- ---------� -�--------r- - -•--•--------------•--•-�---�../_--------------- ------••----------------••-------- - ---------- •he• - r ��/ 1 V• d b �T_ __________•------_-_ Remodeling and/or repairing (describe):-___--J _ --- -------------- ------------------------------------------------------------------------------------ --------------- --- I hereby cerci that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St la S. and rules and regulations f the San Joaquin Local Health District. �7 /f ---`s� --- (Signed)--- - r _.[ nen and/or Contractor) t {Title} { ---------------- BY:-- (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `.v------ ------ --- DATE... .... -------------------------------------------- APPLICATlON.ACCEPTED BY--------------------- -----------------�---- �- DATE.------------- REVIEWEDBY----- ---------- ------------- ----�-- ----- --- ----- ----- ------------- --------------------------------- BUILDING - --•----- ---------------- ---------------- BUILDING PERMIT ISSUED.--------------- ------------------------- DATE------ -- ----------------- - Alterations and/or recommendations:-___-.-.-.-- ___ ---�--- f --- - --- -----•• -- -------------------- ---•---------------•--------------••--------------•----•-----•--•----_---------•---------•----- S._ __. ---_ --- - __.--- __.. _._ r- //�•��) _______________________________________________________________________ ___._F_____. .._.y___ _l'f-..._. - _ . _-N--------------- ----------- ----------------- -. ------------------- ------_---------_----------- -------------__-------------_------------------ -------------------------------------..------------------------------- •___.._.. �f FINAL INSPECTION BY:-----Z. ---------- ----------- - Date--- -------------------------------------- SAN -------- ----------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Stree+ 130 South American Street 300 West Oak Street 132 S Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD