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i(2 APPLICATION FOR SANITATION PERMIT Permit No. ...li... Z` . (Complete in Duplicate) Date Issued 7� Applica-ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION_�p^^-____ ____________ _ QL-�-�-..__�_4,-8-�........ Owner's Name...... . -•---• - ---------------------------------------- .......r— Address..... Q............. .Q ...........6.6 /I-� .�- `?f . Contractor's Name....:. = /--� ct�u °�^'l Phone-- a =:.�lt.�./'��2_ Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �...... Number of bedrooms .1----- Number of baths .-/..... Lot size ....140.........4.... 4........................ Water Supply: Public system ❑ Community system [Z Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No JRJ New Construction: Yes,® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_" istance from foundation.... Q...........Material -�: __f7. --------------- ® No. of compartments_-_.____-02____-__.----Size__._._.k_X_3.4..___:---Liquid depth------ /`'-------------Capacity.....f,9 _ Disposal Field: Distance from nearest well__Zra'`—Distance from foundation-----L.i�.._.....Distance to nearest lot lin ............. [� Number of lines............./_f_,_,---_--__pp_Length of each line----------6. ---------------Width of trench..... _�--___-.-__---___---- Type of filter matenal..-,_5__---.5_-A.Depth of filter material---_.4-�_.-__.....Total length----------lo__19.-_•----------------•_--. Seepage Pit: Distance to nearest well------------_______---Distance from foundation....................Distance to nearest lot line_.._.........._.. ❑ Number of pits--------------- ------Lining material_._._.._. -------------Size: Diameter-------_-------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-__------.__-_--.Lining material -:-_--_-_..------------------.-_-_-_. Size: Diameter--------------------------- ------Depth--- ----- --- _ Liquid _Capacity Privy: Distance from nearest well-------.-----------------------------------------Distance from nearest building.-........................................ ❑ Distance to nearest lot line-------------------------------..................................................................-------------------------------------------- Remodeling --•-------•-----------•------- •--•-------Remodeling and/or repairing (describe)-......................................................................................................................................................... ------------------------------------ ...................................................................-----•--............................................................................................................. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �1 ordinances, Stat e laws, and rules and regulations of the San Joaquin Local Health District. �4 ----------------------------------------------------------------(Owner and/or Contractor,(Signed,•-------- ------• '�--------2nt - -------------------- -----...--------------------------------------------------------- (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 - DATE REVIEWED'BY------------------------ Y... ... DATE -------- ZZ JJ BUILDINGPERMIT ISSUED ....................................................... - ---- - -------------- Alterations and/or recommendations --------- ----- -- -----------•--•--••. ----•-•. •---•-----•--•-•---••-•----•--. •-----........--- ...........................................................--------------- --------------------------------------••------•--•--••......---•-•- -d --- ..... ..........................................................•--•---•--------•----------------------------------- ............... . .r.. . -------------------------------- -- ---------------------------------------- - --- --------- ----- ................................................... I so "� ------ Date---- '� ' 5 -------------- FINAL INSPECTION BY:------ - . . SAN JOAQUIN LOCAL HEALTH DISTRICT V 'C 130 South American Street 300 West Oak Street 132 Sycamore Street 81,+.N" •1C' Street Stockton, California Lodi, California Manteca, California Tracy, California o ES-9-2M 145446 ATWOOD 12-54