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ti APPLICATION FOR SANITATION PERMIT Permit No. .._ __1.5 (Complete in Duplicate) Date Issued __7_`. .�-ra� 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..._ !- - ' - __—7- Owner's Name-------- _ .:...... _ Phone--------� ----- Address..... . ___ �:5. -- ----`---- - ---- � - Contractor's Name / ------------- Phone ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______.- Number of bedrooms .- Number of baths _Z___ Lot size ____--- l3 _------ -------------- ---- Water Supply: Public system ❑ Community system ❑ Private YT-Vepth to Water Table 4W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam RR--Cray Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes e— o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well: _ ____Distance from foundation----r ------- - Material_- No, of compartments------- --------- --Liquid depth--- __ -- _ a acitY ' �ks Disposal Field: Distance from nearest well_>_?q_....Distance from foundation-_07 --------..Distance to nearest lot <. Number of lines---.4-- ---�------------- Length of each line-----„��---- `-- --.Width of trench.--- -------------------- Type of filter material-A4-/ - aDepth of filter mate ria l____�_e_..______.Total length___-__� ---------------_ SeepagePit.- Distance to nearest welL._ !- Distance from foun +jon__A ---------Distance to nearest lot iine_/e:V___-. Number of pits...../-------------Lining material- -4°ize: Diameter.__."__`_” De tn__..__. _ 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 and/or repairing (describe) .-li�.-__-- -- '---------------------------------------- -----------------------------:--------------------------•-----•--------------------------------------------------•------------------------- ----------------------------- ----r-----------------------------------------------------------------•-----•- ----------•--------------------------------------------------•--------------••------------------------•------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San,Joaquin Local Health rDistrict. (Signed) ----- -- !------------------------{®wnowmwd�er Contractor), ., By:_-•--•-:---------------------- ------• --- -�--------may �' - G=s=-------------------•-- -----(Title)------- (Plot plan, showing size of lot ation of system in relationnMverseto wells, buildings, etc., can be placed osid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --------- -- ----- ---- -- -+-------------- DATE------>1 ------------------------------------------ REVIEINED BY - - --- ----- DATE_--------- - BUILDING PERMIT ISSUED------------- ----------------- -- ----- --- ----------------------------------------------- DATE--------------- Alterations and/or recommendations:_...__..____.__ _ _ e. -- - -- --- - --- --------- •--------------------• •------ -•--- ------------------------- -- --•--- - ----- -- -------------- .----------.--------------------- --- ...- ----- - -- -------�------- ---•---------------- ------- ------------------------ FINAL INSPECTION BY:------ ---------— --------------- Date-------- / r V� - ------------------- 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 LS-9-2M iasaae ATWOOD 72-54