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APPLICATION FOR SANITATION PERMIT Permit No. __`.�11__.. �1 G (Complete in Duplicate) � [ 2- Al. A1/,4SS r Date Issued �4-r�1d 112 -----/��-,l-J-. Applica4ion 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 C u ty Ordinan No 9. • JOB ADDRESS A LOC ON. ____ ___ c f�-AP C� Owner's Name ----- -------- - -------- --- -----------------------------•---------------------- -'rl-- ----- Address -< Phone rt Address__. - +: Contractor's Name---- -. --- --••-------------•-- Phone '2- iQ --------- •--- -----------•--------------------• ---- -------------------•- Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f- _ Number of bedrooms .3--- Number of baths 1 --- Y Lot size D'-- F-------/------------------------ Water Supply: Public system ❑ Community system ❑ Private&--D-e-pth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes ❑ No &--I�_e_w Construction: Yes - 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--7 -C.-Distance from foundation-----/_4__'r.Material-----�. ------------- Al' 9L, No. of compartments_.-_. — Size---"----)(__L4_�l___Liquid depth__ -_ Ca -- ---------- ----- -- Disposal Field: Distance from nearest weft ? '_�_ _ -_Distance from foundation•__ _�.f._-.Distance to nearest lot line__ rte- Number of lines___._]_____. _f_ __ _____Length of each line-__._7 -----.----- ----Width of trench._�_.�"-'___------_-_.-.- Type of filter material._ .__- -------------Depth of filter material...._/______._Total length___.____ k,�t------------------------ Seepage - --- -------------- ' l rP - r Seepage Pit: Distance to nearest wellL.fQQ---____Distance om foundation___., S__._..D sfance to nearest lot line_ . [ — Number of pits________ ____________Lining material_ _ _.__.Size: Diameter._. ____De th_._ S � �� P �--�---=--------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material____-__________ ---- _._.___________ 10 V+ ❑ 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 the work will be done in accordance with San Joaquin County ordinances, St law , and r s and egulations of the San Joaquin Local Health District. 1 (Signed)----- --- ---- ---- ------- -- (ems Contractor) By:._... . ---- •• ...��`�1----- ------- ------------------------------------------------------(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 ----- �Tl------------------- - REVIEWEDBY----- ------------- ------------------------- ------- ----- -- - -------------------------------------------------------- DATE---- - ----- ------------- .. BUILDING PERMIT ISSUED------------------------------------ -------- DATE---------- -'--- ,--- - Alterations and/or recommendations:------------------------ -------- - --•------------------------------------------------------------- -••- •------------------ ------------------•----•-- - -/ - -------------------.I—'------------------•-•---------------- _''_ - --------- ------------------•------- Y " r - _ ---------------------------•- ------------ --------------------------------------------------------------------••-•------------- ------ ------------•-------------------------------- '� -•-- FINAL INSPECTION BY:.. 2_- 5------ ------ -------------- Date------�------------ -----`S 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 ES-9-2M 14s446 ATWOOD 12-54