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�l APPLICATION FOR SANITATION PERMIT �}�• Permit No. .--(f- _ (Complete in Duplicate) Date Issued ----- 3-- 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,,99 JOB ADDRESS AND LO TION__-- - ------- cflr•---1----/-_�---SGS-- ----- -- .. ._ � '� ------------- --- Owner's Name------ ----- -- -------------------------------------------------- --------------------------. Phone-------- --------------------------- Address..--------------------------------- / Contractor's Name--------------- ------------ k��---------------------------------------------------- -------------- --.-.._- Phone._.._...---••----------•----------• Installation will serve: Residence o-'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: / ____ Number of bedrooms _5--- Number of baths J__._ Lot size ------`______________________________________________--_-. Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table ------ ft, i Character of soil to a depth of 3 feet: Sand Gravel❑ Sandy Loam �y Loam [] Clay El Adobe E] Hardpan F]Previous Application Made: Yes E] No New Construction: Yes H--�_o ❑ 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__75_______.Distance from foundation_-_-A----___._. Liquid de th._.__13-_-..__ No. of compartments-_*-.---`�-r ----Size_��.� `�:-- --- q depth___13 Disposal Field: Distance from nearest well.15..........Distance from foundafioP___ ____. ,Distance to nearest lot line t -_:_____- Len Length of each line o ' �°, � i° Number o1 lines - j g °---- -�� s- -- -----Width of french .--------- of filter material_ _e Depth of filter material....`_e-e_____--Total length-__.___-.a__ ___ ------------------ Type + Seepage Pit: Distance to nearest well-----___--------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth..-----------------_------------- 9f Cesspool: Distance from nearest well-----------------Distance from foundation:-------------------Lining material------------------------------------- ❑ Size: Diameter------------------------ ----------Depth----------------------------- ------- -------------Liquid Capacity-----------------------------gals. . r - = rivQis.tamce fxom-�nearest-welly — building_- _ ❑ Distance to nearest lot line-------- ------------- I 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`-- ordinances, State laws, and r les andregulation of the San Joaquin Local Health District. S- - --------- --- ---------- (Signed) --------------------------------_--------Owner and/or Contractor By:-------------------------------------------•-------------------------.--------------- --------- ------------------------------------(Title)--------------------------------------------------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' 4 ART NT USE NLY _ t APPLICATION ACCEPTED BY.._._ ---- -- � ------- ------- -- -- ---- --------- ---•-------- ;..DATE--------- --- ��--- ---�/-- ---0--�•�------------------- ( REVIEWEDBY-------------------------------- - --------------------------------------------------------------------------------------- DATE------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------ ----------------------------------- DATE----------------------- -•-----------•---•----- Alterations and/or recommendations:--------------------------------------------------------------- -----------------------•-----•---------••-----•---•-----••-- i F ---------------------------------- ----------------------------------'---------------------------------------------------------------------.--------------------------------------------------------------- ....... 4 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 x ES-9-2M 145446 ATWOOD 12.54