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°I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date issued _/-5 4Apeplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrribed, This application is made in compliance with `Countyy Ordinance No. 5499.. ` [7 JOB ADDRESS AND LOC, IOyN E 7` __. ?O�-_a.JU./LI Y�1 ----�7 i------------ - c+�s a E ---------------------- . -------------------- Owner's Name L" r_ �_ e � -�---- � � - Phone- Address----------------------- Contractor's Name .f' - ----------- - ��v-----------------------------------•--------------------------------------------------- Phone.---"4'-.---- Installation will serve: Residence [?r"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_._ Number of bedrooms --•1'- Number of baths .-f.- Lot size ----l7Q---.K------6-_Q-`---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: Yes ❑ No [Z"' New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ss�� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ept�c apk: Distance from nearest well-_;--------------Distance from foundation--------------------Material__---.-----.-------_-------_.-----..------.-- No. of compartments------- -----Size--------------------------------Liquid depth------------- ------------Capacity----------------------- sat d: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.---------_-.---- /k�f[Yba�j Number of lines-----------------------------------Length of each line------------.-----------------Width of trench----------------------------------- >df:�.n Type of filter material-------- ----------------Depth of filter material-------_--_----_-----.Total length------...---------------__-------------._ J Seepage Distance to nearest well- M-e----_Distantfr m oundation_,10--__--------Distance to nearest lot lineA9____-._ Number of pits.-.-1--------------Lining materiaLC-`...Size: Diameter.___-, -------- ds Depth-- _h,r--1 __ ------- -------s Cesspool: Distance from nearest weft-----------__---Distance from foundation--------------------Lining material--.-.----------.----.------------__--, ❑ Size: Diameter-------------------------- --- -- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals." Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.------------------------------- - ❑ Distance to nearest lot Iine--------------------------------------------- - -------------.-... Remodeling and/or repairing (describe):------------------------------------- -----------•---•-----------------------•--------------------------- ---- -------------------------------------•-----------•----------•--------------------------------• ---•------------------------------------•----------------------_ --- - ---------------------------------------------------------------------------- -- -...--- -------------•---------------------------•--•-•----•----------------•-----=--•-----• p ------------------------------------ --------- ------------------------------- ---------•-------------------------------------------•---...------------------------------------------------------------------------ ---------� I hereby ce ' that I have prep this application and that the work will be done in accordance with San Joaquin County ordinances, Stat I ws, and rules a regulati sof the San Joaquin Local Health District. (Signed)------------- ----- Contractor) ------------------------- -- --- -- ---------- BY: ------------------------ (Ti+le) 1 (Plot plan, showing size of lot, location of system in re ion +o wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ DATE REVIEWEDBY------ --------------- ---------- ----------- -------------------------------------------------------•-----------------------. DATE BUILDING PERMIT ISSUED------------- ------------------------------ ------ DATE-------- Alterations and/or recommenda+ions:---------- -------------------------•---------------------------------------•--------------------•-----•------------------•----------------------- ..-.. .-.. --------------------------------------------------------------------------- ------------------------------------------------•-----------------------------------------------------•-•---------------------------------------- ---•-•---------------------------------------------•---•------------------------------------------------------------------------------------- ------ -. FINAL INSPECTION BY:..--... f ----------------------------------- 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 x 9-2M 145446 ATWOOD 12-54 1