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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 compliance f County groinV No. 549. P 0 r /V, 4 JOB ADDRESS AND- /<-.r-e.11------ -- ---------04�S--c_ )LOCATION .17 �k) // Owner's Nam ---------------- ------------ Phone..---------------------------------- --------r------------------------------- - -- ------------ ,e r Address-------- -- ------ --- --- ....... ------ -------------------_---------------------•--------- ------------------------------------ --- -------- -------71 7 -------------------------------------------------------- ------ Phone_------------------ ------------ -- Contractor's Name...... ---- --------------------- Installation will serve: Residence P--Apartment House [I Commercial E] Trailer Court 0 Motel 0 Other E] Number of living units: Number of bedrooms _3--- Number of baths Lot size __---______________ Water Supply: Public system 0 Community system [I Private [4--Depth to Water Table L:>P ft. Clay El IN Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [] Adobe E3—Hardpan E] Previous Application Made: Yes E] No 9---New Construction: Yes E�-Flo 0 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-j�_ !'_Distance from foundation__/A-------MateriaL-ele..... ------- No. of compartments___-I—LA).0.___._:Size_ uid depth___4..e---------------Capacit --- ir 4--Z-4 y....... -------- Disposal Field: Distance from nearest weil____,5 _"._Distance from foundation_._--i;? ._1---b�isfance to nearest lot line----&___f--- Number ine----&--/--- Number of lines___________ ___ ---------Length of each line--- of.french-------13d) --------------- Type of filter material--/Aw.----5!,C-----Depfh of filter material----- ---- .--Total length----- --------------------- - Seepage Pit: 'Distance to nearest well-J6-D---------Distance from foundafion__j_0_./------Distance.to nearest lot line----Q5- --------------- Number of pits---------I----------Lining materiaSize: Diameter_____3 ............Depth. _Z__ Cesspool: Distance from nearest well-----------------Distance from foundation_____._._.__--..._ Lining material--..-__._._.____-_.----_-._-_--_--. Size: Diameter-------- --------------------------.-.Depth----------------------------------------------------Liquid Capacity--------------------; ----gals. d Privy. Distance from nearest well___________________________________-- -.._.-----Distance from nearest building----.-._--.--_------_-_------.._----.-_--. ❑ Distance uilding------------------------------------------ Distanceto nearest lot line------------------------------------ ---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- ... ....Z-60-------- ------------------------- -------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, S", laws, and rules and regulations of the San Joaquin Local Health District. {Signed} -,/- 'V XaS —/7 -------- -_-1-----------C-----j' ------- ------ - ----- - ------------------------------------------------ )- Owner and/or Contractor) ----------- ----(Title)----6 12*_f ------------------------------------------- ---------------------------- (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY --------------- --------�;------------------------------------------------- APPLICATION ACCEPTED BY-------------------- -- -------------------------------------- DATE - REVIEWED BY-------------------- ......... ----- ----------------- ------- -------------- --- ------------ DATE-------= ------------------------------------- BUILDINGPERMIT ISSUED------------- -------------------- -- ----- -- ------------------------------------------------------ DATE------ -- -- ---- ----------------- ------------- Alterations and/or recommendations:, ---- ------------------ --------- ....... -------- ---e- - -------:--:---- -- --------- --------------------------- ---—------ �c _e' _ -- -- -------- ----- --- -- - --------------------------------------------------- ------------- 4, - --..2 d--s-Z - -, -- I -------------------------------- ------------------------------------------------- ------------3------------------- ------•-------------._....-----.._..-- -------------------- -------------------------- ---------------------- ------------------------------------------------------- ------------------------------------------------------------------------- 4;1; 6 ------------------------------- ------- .......... -------- --------------------------- ----------------------- -------------- --------------------------------- FINAL INSPECTION --------------------- ------ ---------- Date-- -------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-3-2m 145446 ATWOOD 12-54