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a` 5� -_ 7!;Z.3 //A"'7 �y3 . Y APPLICATION FOR SANITATION PERMIT Permit No. _.'7 ti 9.4__...... (Complete in Duplicate) 1 cz, Date Issued ----14x-.3f__S- Applica}ion is hereby made to the San Joaquin Local Health District for a permi o construct and install the work herein described. This application is made in compliance with County Ordinance No.� 9. JOB ADDRESS AND LOCATION f ��! r --- -- ------- .a . Owner's Name---'�7�-------------- -------- - -•---------------••-•------•-------------- --------------------------------- -----.-.-- Phone--------------------•- Addressl /'r ---------•-•---------------------•-•---------------------------------•------•------------------------------------------------------------ Contractor's Name_--- � r------------------------------------------------------------- ------------ Phone-/_0 `I I Installation will serve: Residence 0 Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: I--- Number of bedrooms-. Number of baths .l____ Lot size __,j_ )-_----X___,!4—w------------------------- S Water Supply: Public system IR Community system ElPrivate E] Depthto Water Table ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ M Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No ❑c, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E r Septic Tank: Distance from nearest well-1V�_-,Distance from foundation--/4-1--------Materia -`�-'_-_�.--------_`.`�-�---------------- No. of compartments.._._-_- -_____-_-__Size_„ _. _ _ ._----Liquid depth_--.4-o___---------.-Capacity-_-- � ..-----__- Disposal Field: Distance from nearest well_AZOwo—Distance from foundation___-�-_ --_-_.Distance to nearest lot lir ------------------ Length -_-- �_-r-- Number of lines.......... ....... Length of each line-..----- -e2._...___ __-.-Width of trench_.__ __-.__..____._____._ -W------/---�- !1 ! _ Type of filter material___ ...._.j 1,..Depth of filter material --._-0----.�_..Total length------o2.Q--------------------------`-- U)Seepage Pit: Distance to nearest well_/VA7 --Distance frompQfoup��jation____r a______.Distance to nearest lot line__ __.__ Number of pits.._.__/-__._______Lining materia... r sale: Diameter____.4FS-------- Depth--.. S -------------- 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 lire-------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------- --------- --------------------------------------------•-----------------------------------------•-•------------------------ --------------•-----------••---------------------------•----------------------------------------------------------------------•--•--•--•------------------- ----------------------...----------------------------------------- --------------------------------------------------•-------------•------------------------------•---------------------------------------..--------------------------------•------------------------------------------------ I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta law , and rules and regulations of the San Joaquin Local Health District. (Signed)--------- -----r ---•-- ----------------------I------ ----------.------------------------------------------------------------------------(.Owner and/or ContractorT' ----------- ---------------- -------------- ----------------------------------(Title}._. ,rr `---•----------- (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 REVIEWEDBY--------------------------------- --- s ------------------------•- -------------------------------------- DATE---•---------- '`4-----------------------•-------------- BUILDING PERMIT ISSUED------------------ -- -`P-- DATI__.-...-•._._-- -: `� ---------------------------------------------------------- ; Alterations and/or recommendations:_-_._-.-_-._-.-... `rte -----•-•---------- ----------------- --------------- - ----- -------•------••-------•-----------------------•---------- -- ------------------------------ --- ---- -- ----- - ------- ---------------- : : :::::_:___ :-:: _ _ _ ____ ::::::: __ - '. .�--- `-- --------------------------- -- _(-------------------- ------------------- • -- -- FINAL INSPECTION BY------------- --------------------------- Date----- -)..------ - --------------------------- 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 E5__19-ZM 145446 ATWOOD 1Z-54