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s _ APPLICATION FOR SANITATION PERMIT Permit No. ..�g- -- e (Complete in Du licat Duplicate)1 pate Issued .6; - -sir_- Applica+ion is hereby made to the San JoagyytN�Local Health District for a permit to construct and install the work herein described. This application is made in complian�%55MZZKoKunfy Ordinance No. 549.JOB ADDRESS D L�CAT10 --- ---��►- --------------------------'.... (.--L> Phone--.--.� -�-� � Owners Name---• ---•----- f Address---------- -----.-�-------4... J------. ..... ----------------------------------------...------------------•---------------- Contractor's Name------------------- --------- - ------------------ Phone---------------------------------- Installation will serve: Residence No Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ .'La Number of living units: _1--- Number of bedrooms -- Number aths . ..-- Lot size PP _-- .S _--. _�__ -- ----- i Water Supply: Public system El system E] Private Depth to Water Table -----.-- ft. Character of soil to a depth.of 3 feet: Sand 0 Gravel ❑ Sandy LoClay Loam ❑ Clay E] Adobe Hardpan E]Previous Application Made: Yes ❑ ;/No No V New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if �ublio sewer i available within 260 feet Ip t -. �� Esta ca fro fou ._ tion- Mate i I - = Septic ank: Distance from nearest wel _ _ - `� _ a Li uid cue th--- _- -Ca acit ----- No. of compartments---------�- +--- --- Size-- - ------ --- q ;;.,,P. ii f P Y I�Field: Distance from nearest welt-.0 `D tante from foundation�. .............Distance to nearest lot line_- ..-------. pisposa d Number of lines -- - -------------- --------------Length of each line---f 2'--- b��d--.Width of trench...... "'y------------- Type ---_--•."'y-----------T e of filter material-- 7_ ►Va< De th of filter material------1_ _... Total length----------�_,�-- ---------------- YP � L�-� - - �-- P Seepage Pit: Distance to nearest well............... ......Distance from foundation--------------------Distance to nearest lot line--------___.-_--_ ❑ Number of pits-- ------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia4----------------____--------..------. d Size: Diameter---- ----------------------- ------Depth------------- --------------- ----------------Liquid Capacity------------------------•-gals. # i --_.Distance from nearest building Privy: Distance from nearest well 9 r ❑ ° Distance to near'est lot line-- --------------- -------- --------------------------------------------------------------- ------------------ --------- 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 rules and regulations of the San Joaquin Locel Health District: -- ---------------- (Signed6 -----------------(Owner and/or Contractor) , 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 1 - = DATE----------------------------------------------------------- REVIEWEDBY-------------------------------- ------- ------------------------ ------------ _---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------- ---------•----- ► Alterations and/or recommendations:--........ ...... --- - ,------..---------------------------•••------------------ ' p- - Q -------•--------- a. -------------------- �..-• . ---------------------` - " £= ----- f ----------------------------------------------------------------------- ..... .............. a� ------..-- .- ------- ------------------- ------------------ � ------ Date -- a---------------------------------------------- FINAL INSPECTION BY---------------------••- ---------- �. R� 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes# Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2M 145446 ATWOOD 12-54 k __