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APPLICATION FOR SANITATION PERMIT Permit No. -Z7_.7._--------- (Complete __- _ (Complete in Duplicate) Date Issued --7-"-!•-r-'--J � 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 , mpliance with County Ordinance No. 544. �-7 3 JOB ADDRESS AND LOCATION--_7 _:�1 ------- - Owner's Name--------- --•C_1!1� - ---- --- ..------ •,r ---------------- -- - ------------------------------------- Phone-----------------------•--------- Address-------- d -•------• Contractor's Name �•r -- *f' L�L — ------------------------------------------------- Phone- Installation will serve: Residence ❑ Apartment House ❑ Commercial ,Z _Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths - Lot size -_.-- -- Water Supply: Public system ❑ Community system ❑ Private Depth to Wafter Table �'1� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [_ New Construction: Yes k No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) — A r Septic Tank: Distance from nearest well—.9 j-__Distance from foundation___,_!5 _.-------Mat rial--_ - Q No. of compartments------ ---------------Size �_ � Liquid de th_--- ----------Capacity--.-ra ____--___ - i Disposal Field: Distance from nearest well._��--_-.--Distance from foundation_--�d---__-._-Distance to nearest lot line._-l��!_......- Number of lines----------- -- - Length of each line-___-----��--r_ ___---Width of trench_----*-_ r!___-.________ ` ___` �f ' Type or filter material---1�--_- W Depth of filter material--- _ ..........Total length---------- (�1 _ 1 Seepage Pit: - Distance to nearest well.... h__-------Distance from foundation....l/Q--___.Distance to nearest lot line-___f�p.� Number of pits--------/ -------Lining materia1..<?-Aa--4.'Vze: Diameter__--._ !� Depth ....... - ------------ Cesspool: __F---_--_Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------ ------------------- ,� ❑ Size: Diameter------------------ --- ----- ---------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---,-------------------------------------------- -Distance from nearest building-------------.---------------_-_----_-- ❑ Distance to nearest lot line--------------------------------------------- -------------------- -------- ------------------------------ Remodeling and/or repairing (describe):------ --- -------- -----------------------------------------------------------------------•------------------------•----••--------•------- ------------------••--------------------------------------------•-----------•-------:-------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- --------- ---•------------------------- ------------------(Owner and/or Contractor) BY:--- - ---------------------------------(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 BY------------- -- - -- ---------------------•------------------------ ----------- DATE--- REVIEWED BY--------------------------------------- ------- DATE---- BUILDING PERMIT ISSUED-------------- DATE ------------------------------------ Alterations and/or recommendations--- ------------ - ------ ---------------------------------------------------------•-•----•-••------------------•-------•-- ---------•-•--•---•----- --- -- --------• ..........:....--------------------------------------------.... --- -----•••------------------------ --------- --------- ------- -- ------------------------------ 77 FINAL INSPECTION BY:::----- 5------------------- ------------- Date------- ------------ SAN ---------JSAN 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 145445 ATWOOD 72-54