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1� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) l� Date Issued 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 complian a with Couunt Ordinance No. 549. JOB ADDRESS A LOCATION ...... - ---- � c f� yy Owner's Name----- - - - ----••-.�tlrYs�+r¢..------ --- ..-•--- ---- -------- -------- Phone------------------------------------ Address --------------- -•-••------------ Address----------•------------------------------------' r : --------------------------------------------•--------------------------------------------•-------------------*...... Contractor's Name___0?4_ ---U--'fr�0 ..'A--Z4 �------------------ ---------------- Phonelr'�-_�~.�_�i Installation will serve: Residence [-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_--_ Number of bedrooms _ _. Number of baths)_�a Lot size _._ _ ----_ __ _!Z_A--------------------- Water Supply: Public system M—e—ommunity system ❑ Private ❑ Depth to Water Table V//74. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes E❑ No 9t__Uew Construction: Yes L4-.LLLQ 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 _ _ Distance from foundation__.__ _ Material__.. ----------------- ---.-. `t- RL--. No. of compartments--___ -------- -------Liquid depth___ ___Capacity._jdgQ------ Disposal Field: Distance from nearest wel .Distance from foundation___. 1b_!------Distance to nearest lot line_____..___. Number of lines-_-.-_---.- _ Length of each line-.----- !_ Width of french------ ' Type or filter material- _._-_ Depth of filter material_._... ----Total length---___._ Seepage Pit: Distance to nearest well .._Distance om f ndation___._1_d___.- Distance to nearest lot line_..__------ [ Number of pits----_/-------------Lining material._. k+± ___Size: Diameter___r _..__._.___Depth---�0... ........_-_..__._ Cesspool: Distance from nearest well_________________Distance from foundation.....----------- lining material-----.--------------------_____-----. _ [] Size: Diameter -------------------------------------Depfh------------------------------ ------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.______.-______----_----_----.--_---..__- \ ❑ Distance to nearest lot line-------- -------------------------------------•--------------.---------------------•- •-----------•---------------------------------------- Remodelingand/or repairing (describe):-------- -------------------------------------------------------------------------------------------•---------------------------------------------•-- •--••----------------------------------------------•I--------------------•--------------------------------------------------------------------•-•---------------------------------------------------------------------------- -------------------------------------------------------•-•-----------------------------------------------------------••----------------------------------------------------------•------••-------------------------------- ------- ----------------- -------------------------------------------------------•--------------------------••--------------------------------------•-----------------------•------------------------------------- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Ia law , andr es and regulations f the San Joaquin Local Health District. (Signed).. .- -- r Contractor) wf e en showing size of lot location of tem n relation to welis, buildings, etc., can beplacedon r Plot Ian s � g averse side). � I plan, 9 Y � FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- --- ----- -------------------------------------------------------- DAT ------------------ ------------------------ REVIEWEDBY---------------------------------- ---- - - ---------- - --- ----- --------------------------------------- --------- DATE---- -------- - \ BUILDING PERMIT ISSUED---------------- ---------- -- DATE------------- -�-�'--------------- ---------------------- Alterations and/or recommendations ------ --------------- - ------- J------------------•- ----------------------------------------------------------- - �------•-•- ---- •. -- ---------------------------•-• ••---------------------- -- ------------- --- ------------------------------- ------ --------------� --------------------------•-------•--------------•--•---------------------------------------------------------------------------- ---------------------------------------------- ---------------------------•--- ------------------ ------------------------- ----------------------- ---- --------- ----------- -------------•------------------ -•------------------- +�-� — �. f -� I FINAL INSPECTION BY:--------- _---- ---- -------------- Date---------------------------------11 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 ATWOUD 12-54