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APPLICATION FOR SANITATION PERMIT Permit No. .../.0:.3.,4�`,� (Complete in Duplicate) Date Issued ....,1 .._. 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 CountyOrdinanceNo. 54.9.. JOB ADDRESS AND LO TION.---- ---_�__/_L "'`'��c" --- ------------------------------------------------------------------------------------ Owner's Name................... *Q..�l.�l� � Phone �j �} .. Address-----------------/---6 ff-7-3........... -•---- -• - -- -------- --e-A-------------•---------------... -------------------------------------------------.- Contractor's Name.................... -•---••• ---------------------------------------------------------------------------------••--•-•-------•----- Phone................................... Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms A..... Number of baths ---I--- Lot size -__{9__Q_x._t 0.6-_----•______________________ Water Supply: Public system ❑ Community system IN( Private ❑ Depth to Water Table 74ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (;( Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: YesA No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A Septic Tank: Distance from nearest well. ----Distance from foundation----J_ .___.Mater'aL..._ i1 No. of compartments___.____Y' ....Size------- Liquid depth........ -------Capacity...210 Dispo al Field: Distance from nearest well---- -Distance from foundation......Z--± ..._..Distance to nearest lot li e.—<......... Number of lines.__.....3-------- --------------Length of each line___- _`f.HD f 11 Width of trench X-_X...._.__....______.___ � Type of filter material__c5T-j-�P-;it -_Depth of filter material-----/-.S----.-.-__Total length.....90........................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-.--------------- ._._-.---- 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)----------------------- ------- -------------------------•-------------------------•-------------------------...----•---------------------...._.._...... ---------------------------•-........-•----------•------------•---------------------------------------------------------------------------•---------------------------------------------------•------------------------------- ------------------------ -------------------- ---------------•------...------------------------•-------------------------------------------------------------------------------------....------------------------------------ I hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St I a d les an regu ns of the San Joaquin Local Health District. s, r (Signe ...... ••. ---------------- -----------------------------------------------------------------(Owner and/or 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 APPLICATION ACCEPTED BY--------------- ---------- ------- ------ ---- ------------------ DATE---------------------------------------------- ------------ REVIEWEDBY-------------------------------------------- ----------------------- --•- -- -----•-•--••----•- DATE--------- r/ BUILDING PERMIT ISSUED DATE--------- - II, Alterations and/or recommendations:-------------------- ----- ------------ ---------------•-•-•••---------------------------•------•--------•--•------•--•-•-•• ------ ...-•-••-••------•---•----•-••••---•-------------------•...---•----•-•-•---------------•---------------------••--•...-•-----•-•-------••-•--••----•-•------...---•-----•-----•-------••....-------•---••-•-•..........•. ----•---------------------------------------------------------•-----------------------------------------------------•--------------------------•.•---------------------.-------------•--------------------------------------- -----•--•--•----------•---•-•-----------------•----•--•----•.....-•-------------------------._......---------------------------------------...------------------------------...._..._....----------------------------------•-. ------------ FINAL INSPECTION BY:------ ...... Date ------------------------------ 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 ES-9 745446 ATWOOD