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041' ._-. ../..-•- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued . . p� _ D�t?.� C� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins all the wor herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A LO TION--- - -- __C! � `'' - -- ---------- - � .. . Phone------------------------•-------•--- Owner' - ------ •--------------------------------- ---------�-----_Yf •-_----- Address.-_ -- .._.-- -- -- ----------------------------------------------- Phon .'s-1 Contractor's Name.. Installation will serve: Residence L-4artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: -_/_"-- Number of bedrooms --2- Number of baths ./--- Lot size _____/.&--- Q------------------ Water Supply: Public system C1 Community system El Private th to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 14— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1/0 Septic Tank: Distance from nearest well---70--,--Distance from foundation_.1:-_q_ _....Mate ic�l_-- _ _ __ -------- No. of compartments---_--..x........------size_. _Ge.- •--1 ..Q---Liquid depth..._.. V"--------Capacity.-- - -Sri------ Disposal Field: Distance from nearest well._.7_fo_'..-Distance from foundation __.Dostance to nearest lot RL,,,,.,, Number of lines---------- Length of each line------- ---.'......-- .Width of trench-..110`'_-.__-.-_____.___ Type of filter matenaL--- -_.v---------.-Depth of filter material-_.._.f __.._-Total length-.___..°-------__________________-- l r Seepage Pit: Distance to nearest well__�o_la---------Distance f m fou dation_..._ .___.Distance to nearest lot line---- _ _.__. Number of pits ----- Lining material_--_ ri✓ -Size: Diameter--?3-------------Depth_ rl._s______-------__-__ 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 ------------------------ -----------Remodeling and/or repairing {describe)------------------------------------------ ----------------------------------------------------- ---------------------•------..._ --•--•---•-----------• r -----------------•----------•-•----------- ----------------------------------------------------------------------------------------------•------------•-- ---------------------------..---. . ------------------•----------------------• -----•--------•-•-----•------------------------------------•------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---------(Owffer-8711M Contractor) " By:---- ----------- ------------------------------------------------------------ - ---(Title)-----------------------•---------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_--------------------- ------ -------------------------•--------------------- DATE--------- ------- - - - - - --------------------------------- DATE- REVIEWED BY-------------------------------- - - y BUILDING PERMIT ISSUED-------------- ------ DATE.- ------ Alterations and/or recommendations: --------- -----------------------------------------------------------•------------------ -------------------------------------------------------------------------------- ------------ -- --------------------------------------------------------------------------------------- ---- FINAL INSPECTION BY:__ -�.~ Date---------- ------------1-^=--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES___9_:?M 145445 ATWOOD 12-54