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qq APPLICATION FOR SANITATION PERMIT Permit No. � (Complete in Duplicate) Date Issued __-9 _`- 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 Ordinance No. 54'9.` (� �.y� JOB ADDRESS AND LOCATION---" -- --- c'---- -" ---=---=`------�'�--`�z;'-• Owner's Name --------- Phone Address--2-o ---- ------ ------------------------------------ - � Contractor's Name.--- �._ ---------------- Phon -- --•-_--- ------ ----------------- Installation,will serve: Residence par ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l ---- Number of bedrooms 1,Number of baths _4_.--- Lot size -,A�r----e_A, ^A-------------------------- Water Supply: Public system [ICommunity system ElPrivate?2—Depth to Water Table 10 ft. / Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamay Loam ❑ Clay ❑ Adobe❑ Hardpan 0 Previous Application Made: Yes0 No.J dew 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__ o -__.__Distance from foundation 4_ /_0 ---Liquid ___Mate iai__- .__.__ ._..______.-....._ .____.. Na. of compartments...__...- ---.-.--Sizej" - --- depth--Z/-- -------Capacity---_ J -- i Dispa al Field: Distance from nearest well--4- 0....._Distance from foundation___Z ------.Distance to nearest lot lme___Id.•_. Number of lines_________ ____ Length of each line------ �. �..O-Width of trench_...__` -----.Total length--------07--s"----fi+_Q-.-.._._. Type of filter material-_.. ___ ____________Depth of filter matenaL._._.� .__ � - � / r Seepage Pit: Distance to nearest well---16_Q._..._Distance from fou dation__Ts�_�.--_--.Distance to nearest lot line--./__O_.. Number of pits- -----I------ -------Lining material_ size: Diameter ----Depth-----' Cesspool: Distance from nearest well--------------__Distance from foundation...-__.....___.....Lining material------------------------------------- F1 -._____--__-_-_.._.- ---.---__. ❑ Size: Diameter---------------------------- --------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well...-.._-_--.-__--------------------------------Distance from nearest building---------------------------- -----g ❑ Distance to nearest lot line-- -------------------------------------------- -------------------------------------------------------------�-------------------------------- Remodeling and/or repairing (describe):--------------------- --- -----------••--------;----------- ---- ----------- _________________ __C_________.__ ___.._____ _-_____ _____.__.._____.__..._._..--_-___----____'______r__ 1�-_.__ _. -----------_--- _ _ ________________________________ -------------------------------------------_-----------------------•------------------------------------- __-_____ I hereby certify that l 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. r (Signed) -- -------------- ------------------------------------- --------------------- --�Ownerd/or Contractor) By:-- - Title l ( ) ---------------------------- (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 APPLICATIONACCEPTED BY--------- .:f ------ --- --------------° --------------------------------------- ------ DATE- ---- ------------ -- ----------------------------- REVIEWED BY------------------------- -------- - DATE----- --- BUILDING PERMIT ISSUED--------------------- -------------------------------- DATE -��--1''-�---------- ------ -- f / Y Alterations and/or recommendations------------ ----- ----------------- - -----------------------------------•----------------------------•--•------- ----------•-------------------------•--- -------------------------------------- --------------------------------- --------------------- ---------------------------------------------- - - FINAL' INSPECTION BY:....`.......- --- 6242ca 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-4-2M 145446 ATWOOD 12-54