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APPLICATION FOR SANITATION PERMIT Permit No. .-77_—'.63.____-_.. (Complete in Duplicate) Di;`e issued _.-��` ` Applicafion 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 ,r ---'`-,--f----- r�_ hone-------------- ----------------•---- Owner's Name--------------4-------P------------ ------------------------- 1 t -------- ------------------ -------------•-------------------------------------------- ------------------------------- �/ R, Phone----------------------------------- Contractors Name___._ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ s Number of living units: _r____ Number of bedrooms -------- Number of baths -------- Lot size ----_"" �.-""_" --------------------- Water Supply: Public system ❑ Community system [IPrivate P Depth to Water Table _eft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made. Yes ❑ No C?�` New Construction: Yes ❑ No Imo_ TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f �+ Septic Tank: Distance from nearest well--- Distance Distance from foundation_.."f0_______.Material____ _ C-" --� """"------ --. M-Li uid depth_.___ C --- ------ Capacity-- k__-"-- IJo, of compartments--------- Size - Disposal Field: Distance from nearest well---- P -"Distance from foundation___..2 _ --Distance to nearest lot �/ Number of lines.--- -----_-"_l -. Length of each line--------1�-Q.---..�-----Width of trench_._---�-�--_--------"-__-- r ---- --- Total len th `----------------------- Type or filter mate nal__�_ __-3,.P a_Depth of filter material.._.. .�___._- g Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits--------------- ------Lining material-----------------------Size: Diameter----------------------Depth------------------------------- \ F Cesspool: Distance from nearest well._______..-.----Distance from foundation------------------_Lining material------------------------------------ ❑ Size: Diameter---------------------- --- -----------Depth.---- --------------- ----------------------------Liquid Capacity----------------------------gals 1 F , Privy: Distance from nearest well------------------------------------- Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line------------------"------- - --- ----- ------------- F, --M ��r Remo elfin9 and/or ren ''--='��---- ----- repairing (describe): P --------------------------------------------------I-------------------------------------------------------------------E -------- z- — ____ __ ` ------------------------------------------------------------------------------------------------------•--------------------------------- I hereby certify that i have prepared this application and that the 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) (Signed).------•- --- --- ---- -- - - - -------------------------------------- ------- --- ---- - -------- -- -- ----------------- (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 4 APPLICATION ACCEPTED BY_' -------------- --------- -- --------------- ------------------------- DATE_ REVIEWED BY----- -------- DATE.-AD---�------------------------------------------------ ----- BUILDING PERMIT ISSUED--------- --•----------- DATE------E'------------------------------------------------ ----------------------------------------------- �1` F! Alterations and/or recommendations:--------------- ------------------- ----------- ------------------------------------------ ----------------------------------------------------------------- s - ------------------------ ---------------------------------------------------------------_----- f ---------------------------------•----------- ---- - - - ---------------------------------------------------------------- -- ------- -------- ---- FINAL INSPECTION BY:---- ---- - ----- = ... ,... Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton, California Lodi,.California Manteca, California Tracy, California e ES-9-2M 145446 ATWOOD i2-54