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�r y APPLICATION 1=0R SANITATEON PERMIT Permit No. .-- .__-_ GL _ (Complete in Duplicate) Date Issued �,9/- --- Applica4,ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. ,�j pf_ ---------------------------------••------• ------ i JOB ADDRESS AND LOC�fION.__/-�j�-��-1P'-----�----�--�"�►------- Owner's Name-----------_.S. --' =1 - ....... �?.>K--------- ��.M.... i I- Address. �••- ---------- ---------- Phone------------------------------------ -- a ._ --------------- ---------------- -- ------------------------------------------------------------------•------------------------- --------••--- Contractors Name �t t Y` -"- •----------- Phone..---•-•----------•---------------- tL�'+Aj Installation will serve: Residence Apartment House ❑ Commercial sailer Court ❑ Motel ❑ Other ❑ Number of living units:.-f------ Number of bedrooms -------- Number of baths ________ Lot size --------��L`f+ -------------- Water Supply: Public system tn--Community system ❑ Private ❑ Depth to Water Tably _4`�J. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe��Hardpan ❑ ,s Previous Application Made: Yes E] No D?L-. New Construction: Yes Z.--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool Qe' itted if public sewer is available within 200 feet.] t Septic Tek: istance from nearest well--.---. -Distance from foundation___________________.Material________________.�____.__-________.____.__-_-.. �l of compartments------ -------------------Size--------------------------------Liquid depth------------------------.-Capacity----------------------- E� I Disposal Field: istance from nearest well-________________Distance from foundation-----------------.._Distance to nearest lot line----------- ber of lines---'.-------------------------------Length of each line------------------------------Width of trench------------------ ------------•--- T pe of filter material-------------------------Depth of filter material----------------------- length-------.--------------.------------------- OF �r Seepage Pit: Distance to nearest well-----/V1724 Distance from foundaj�iIon___ ?�.___- _.._.Distance to nearest lot line_.__`__.._.. 4 Number of pits-_= _�______________Lining material-C.0-_ 'ze: Diameter____10&4.�r ._Depth_.___ -�' � -_____ 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---------.------------------•--------------------- ------------ ---••----------------------•--------------------------------------- r - Remodeling and/or repairing (describe):--------------------- -------------------------••-----------------------------••---------------•----••----.-------------------- --------------- -------------------------•------ --•--------- ------ --------------------------------------------------------- - ------�---•----------------------•---•-----------•--------------------- ------------------------------------------1------ ------------------------------------------------------....-------•----- -----------•-------•-----•---------------.-----•-----•--------------------•---------------- hereby certifyt I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+ate S. a rules and regulations of the San Joaquin Local Health District. Y- ------- ---- -------------------------------------------------------------tOw rand/or Contractor) ---ev - - _ --------------- ----------------------[Title)-- - Sy=--- [Plot plan. s ize of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- �;�1' - - --------- ----------------------------------------------- DATE------------------ REVIEWED BY -I ------------- ---------- DATE_'X f� �--1 ----:----------- 4 -------------- DATE----' -------------------------------- BUILDING PERMIT ISSUED------------- -----------Z ----•--------------•------------ Alterations and/or recommendations:----------------------------- •----------•----------. - ,• -- - ------•--•---••-- - Al •------- _ �- -, : -------------- ------------------------------------------------------------------- .___.___.._-________. r --------•-- --�- ----------------- ---------------•- - ------------------ �----- i 4 FINAL INSPECTION BY::---- `- ---- Date.-- v---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street in Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es--9—ZM 145446 ATWOOD Ix Sa