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�2� t APPLICATION FOR SANITATION PERMIT Permit No. ._. l..Y-.... (Complete in Duplicate) Date Issued __<� o -�' 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 Ordiroice No. szowdol.,�-4 JOB ADDRESSf�I LOC �C_I- JO?/ U,tt� 1��8/� Lu�----- .. �! Owner's Name � -`=-•- � - . r--------------------------------------------------------------------------------------- Pho .. � !3 V. Address `+ / 5�..3 f = -------------•------------------------------- ---------------•-----.--- �-+ Contractors Name------ :o'_`:.__c�_91?_--1�_..---.Z;PV_1;�f------------------------------------------------------ Phone./,,Z4_. ��- - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./._.-- Number of bedrooms I_.- Number of baths Z__.. Lot size Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table a-Wft. Character of soil to a depth of 3 feet: S� Ne`wConsfrucfion: d ❑ vel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe lardpan ❑ Previous Application Made: Yes E] No Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well. &lfl_"`__Distance from foundation---l_6Material___________________ _• ....` ..... Ldp No. of compartments_.----Z---------------Size__ W!1L_ L!9Liquid depth_-..T_X!!--------Capacity_.-9�v.Q-___ Disposal field: Distance from nearest well.��._Distance rom foundation_..-,l __ •�Distance to nearest lot li ._...__._. ^� Number of lines......f_ _ _.. , _...___Length of each line____:_.��..-�..__ .......Width of trench. a�'._�.._��______________ Type of filter material_4% '__ ' _-Depth of filter material.__-/_X-__ g Total length y ------------------------ Seepage Pit: Distance to nearest well__--------------------Distance from foundation__-_-________----_-.Distance to nearest lot line____.___-___--.-- p ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---.----------------------._..._.._.._. ❑ Size: Diameter----•-- -•----Depth------_--••---•-•-----------------------------------Liquid Capacity............................gais. Privy: Distance from nearest well____________ _____________________._____-_._Distance from nearest building_-________._-________-_______-____-___-- S ❑ Distance to nearest lot line--------- ------------------------------------ ---•-----••------•------••-----------•---------------•---------------- Remodelingand/or repairing (describe):------------------ ------------------------------..............................................-•-•--•---•--------•-------------------------------•---• V -------••------------------------•-•-•---------------•-----.._..---------•-•----........_..-------------------•-----•----------•------•-------•---------••-•-------------------•--------•-•--•--•-•---------•------------•--- ------------- -•--•------•. --._... .................................................---•------•--•---•-----------------•-----•--------•••-•••----------------------------••--•---------••-......--•-------•--•------- ---------- -• -------------• ---- -----------------------•--•----------••-----•---•-----•----•----•--------------••-----•--•----------------------•-•-•------------•---•---•----•...................... --------------- I reby certify t t I have pa and that the work will be done in accordance with San Joaquin County 1 ordinanc tate law and r`les nd reg la ns of the San Joaquin Local Health District. (Signed) C`�.��J �- ---. -''--- -------- �c., can :( La Contractor) B • (Title) Y•---------------------------------------------------------------------- ---k-• •. •-------•-• -------. -- .... ---------------- (Plot plan, showing size of lot, location of system in rela • o wells, buildings, be placed on reverse side). FOR EPARTMENT USE ONLY ----------------------------------------------- ----._ DATE... . --•- ------------------------------------------ APPLICATION ACCEPTED BY--------------- .._. .__ '! d/�'''' REVIEWED BY------------------------------------- ------- ---------------------------------------------------- DATE__..... BUILDINGPERMIT ISSUED......................&- -------------------------•-------------------------------------.- DATE-- Alterationsand/or recommendations---------------------------------------------- --------------------------------•------------------•---•------------•--------•--•------------------------------- -•------•-----------•------------------•- --------------------- -------------------- _ --------- .........................----------------------------------------------------------------------------------- .. ----------------------------------------------------------------------------------------------------•-----•----..---.---------------------•---------------------------------------------------------------------------------- --------------------•--------------------------------- ----------- -----------------------------------------------------•--------------------------------------------------------------------------------------------- -------------------------- ------------- -------- --- ----- -----------. ............ ----------------------------------------------------------------------------------------------------- - / FINAL INSPECTION BY:.................... 2-�--=- ( Date----------------------1... / 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-9-2M 145446 ATWOOD 12-54