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1� APPLICATION FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate) Date Issued _.__ - I- � Applica+ion is hereby made #o 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. �t lo. -�",o c fie. �f.,.cc11 i. 12 JO AND LOCATION..IJ/1! p./v� j Owner's Name_.. lP V�------••--- -------------------------------------------- ' Address f .c2_• ne ------•-------•-- Con#rector's Name._ _ - ?! ----•-- Phone _ ---------- Installation will serve: Residence `---- ®Apartment House ❑ Commercial ❑ Trailer Court Number of living units: ❑ .Motel ❑ Other ❑ . �___. Number of bedrooms ,�-. Number o{ baths _ x_ Lot size __-___� Water Supply: Public system ------------- Y ❑ Community system Y y ❑ Private�,Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Previous Application Made: -Yes El No ❑ Clay Loam ❑ Clay El Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:Construction: Yes No El (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___& r Distance from foundation---- -Q__--- _Material-_- No. of compartments....._- -------f--_Size-- _ , r - - ----------------- - -- --�---Liquid depth._�R__Q-------------Capacity Disp14 osal Field: Distance from nearest well___,9._S__-.-_Distance from foundation_. 40-10-------Distance to nearest lot lin� __f 1 Number of lines__________._. Length of each line------__ Z f Type of filter material__- -��7--.-------Width of trench.-_--.c�_SL_ i_--�Rc-Depth of filter material__..-- e` -------- Seepage Pit; Distance to nearest well_. -- ---Total length-__•-___: rte. ---------- --- ��`�-�.-.--_Distance from foundation__ __ _ _ /�� Number of pits...-_.--f_-________Linin material.-�_ �------ Distance to nearest lot line-----f Lining C�l�-G Diameter �.i .Depth.._-... ��f Cesspool: Distance from nearest well-______________---Distance from foundation__.__-___._. ------.Lining material---------------------------------- Privy: --------------------- - ❑ Size: Diameter---------------------------- - ------Depth---•- --------- - ----- ---•-- •-Liquid Capacity---------------------------- Privy: Distance from nearest +yell_______________________ gals. y ---------------Distance from nearest building ❑ # Distance to nearest lot line-_.__.._._ -- ---------------- ----- -- Remodeling and/or repairing (describe)---------------------- ------------ --- --------•------------------------------------------------------------------------------------------ ------------------------------•--•--- -----------•--•-------• ------• -------------------------------•------•----------------------- --------•--------------•---•--•-------------------- ---------------------------------•-_•--•------------------- ----- --- 1' I hereby certif I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, an rules and regulations of the San Joaquin Local Health District. tY ( dr1 ----- - By:_ _ -----------------(Owner and/or Contractor) = ---- . [rtre) r Plot plan,_':5 owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ t ----- ----------------------------------------------------------------- REVIEWED BY - DATE_ r ----•-------- ------ DATE ----------- _r --- BUILDING PERMIT ISSUED----------_-••- �--�:------•-•-------------_--- • --_-•---- ___ - DATE. Alterations and/or recommendations:_--__._.__ --_- -------'--"-- - ------ ---••---•--------------------- --------------------------------- --••--•- ---•----------- -f --- ------------------------------------------------- _--------------------------------------------------------------------- ---------------- -----•---- FINAL INSPECTION BY:_._.. . � -------...............-- Date----- SAN - --SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street - 814 North "C" Street Lodi, California Manteca, California Tracy, California E5-a-2M 745446 ATWOOD 72-54