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��0 APPLICATION FOR SANITATION PERMIT Permit No. . 17. .-...- {Complete in Duplicate) Date Issued jl� Applica4,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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION... 2��---------.I��P/7___-,-6/•_-____________ __ __ ----------------------------------------- Owner's Name----e!4 FGA,j✓------------' `,F,¢'---------------------------------------- ----- ---------------------------------- Phone-------------- Address------•-- SCJ �'E Contractor's Name------ -- IP--S-- ._- /✓ ° ---- ---- ----------------------------------•--------------------------------- ----------------- Phone-4__4�.'.f'.g<'d__7------ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .Number of living units: __/--- Number of bedrooms _-.2-Number of baths ._o�--- Lot size ---157 � ��- --------------------------------- Water Supply: Public system ❑ Community system ❑ Private [9—Depth to Water Table -------- ft. \4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[9.—Hardpan ❑ �� Previous Application Made: Yes ❑ No [r- New Construction: Yes ❑ No N_ 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-----------------Distance from foundation-------------------Material----------------------.-.--.__------.------------ ❑ No. of compartments---------------------=----Size--------------------------------Liquid depth---------------------- ---Ca pacit y----------------------- Disposal Field: :Di ' stance from nearest•well----__.�__.-�Distance from foundation--------------------Distance to nearest lot line____----_---_-_. 1 ❑ �Yis�s'7f Number of lines-----------------------------------Length of each line-----------------------:-----.Width of trench------------•----------_ ----------- Type of filter material-------------------------Depth of filter material-------------...-......Total length------------------- ---------------------- I 1 Seepage Pit: Distance to nearest w II-��=+ --'- Distance from foundation----2A_..---.Distance to nearest lot line-- a .Number of pit s#-------- ------Lining material__jF��,CSize: Diameter---W."!--------Depth---------� ------------- � x , Cesspool: Distance from nearest from foundation------------------- Lining material----------------------------._-___--_. ❑ Size: Diameter------------------- - ;...Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: rDistance from nearest,welL------------------------------------------------Distance from nearest building--------_-----.----------_--_----.-----._. ❑ - _Distance to nearest lot � lne-----------------=-------------------T------------ ----------------- ---•-------------------•-------------------------------------------------- Remodeling and or ,re airing (describe):_.- - � i' / ---�----- ------ �=--------------------� / ----------------- ---------------------------------------------I--•--------- -- ---------------------------------------------------------- ----------------- ----------• --- ---------------------------------------------•--------------------------------------------------------------------------------------------------------•-- _ -------------------------- I hereby certify that-I have prepared this application and that the work-will.-be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- R�. -�--- y C+ --------------------------------- ( ner and/or Contractor) By:.----- ---- ---- t v�1'---------------------------------(Title)-----a"... . ----` (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 k APPLICATION ACCEPTED BY------ ------------------ -- -------------------------------------------- DATE-----------�S------------------- ------------------------- REVIEWED BY--------------------------------------- ------------- ------ DATE-----------------BUILDING PERMIT ISSUED----------------- -------------------- ---- ------------------ ---------------------------------- DATE.------------- - Alterations and/or recommendations:----------------------- -------- -- _ �, _ y ------------------------------------- ..� -------- g= f ^ �.A>;*V--- -..------- ----- ---- � - - _:� = -------------------- ' ---c- -------- " - .�'° ' ---`-------�--`�----------------------------- ------------------ --------- ---------------------I--------- / -- FINAL INSPECTION BY:- ------------ Date ----*--------- --- --_--� ----- ---- SAN --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 145446 ATWOOD 12-54