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l X153 - k-APPLICATION FOR SANITATION PERMIT Permit No. -7G--.- X (Complete in Duplicate) Date Issued I 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 complia with Co TyOrdinance No:;549. r JOB ADDRESS A LOCAT! lv-.-�..�------ - ------ Owner's ----Owner's Name--- - -----------------_--------------------------- Phone 4r Q Address----------- --- -------I -��-.-----�--------- --- ----- - - -�� ---- ----- --------------------------......----------------�-// -``--•pp---`----------- Phone Contractor's Name---- •-•- ----------•----� -�---yam------- ------------------------------- Installation will serve: Residence Apartment House ❑ CC mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ber of baths /---- Lot size ____ _/.40,ke-'---------------------•- Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table --------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam EK Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E] No�ejwc�/`/'j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_�0..._.Distance from fou,dation-Al--_ -----. Material--------------------- -..-. No. of compartments-Z.____.- _--Si eq.__A ___.- Liquid depth.__o ri Capacit _. . t+ p_*_...Distance to nearest lot line X Disposal F' Id: Distance from nearest well:�.�_�._Distance rom oundation___ ____. _ Number of lines-----1'_-__--.�-- --- -- -- .- 9 �� 14 --Length of each line----�Q(J--------------Width of trench---��-�j�_------------__._-- Type of filter material-_�_�11-..-I[_Depth of filter material_-._. �-_--_.Total length_ ( -- ----------------------- Seepage Pit: Distance to nearest well-_.._.---------------Distance from foundation--------------------Distance to,nearest lot line--.-------------- ❑ Number of pits.-------a----------Lining material----"------------------Size: Diameter-----------------------Depth------------------------.-- -.--- �^ Cesspool: Distance from nearest well-----------------Distance from foundation................... Lining material------------------------------ ❑ Size: Diameter------------------ -- ----------------Depth------------------------------ ---------------------Liquid Capacity------------------- -------- D Privy: Distance from nearest well.................._----.._.______.._--'.......Distance from nearest building------------------------------------------ p ❑ Distance to nearest lot line----- --------------------------------- ----- -•------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- - -------------------- - -------------------------------------- I-------------------------- --•------ ---------------------------- ------------•-•--------•--------------•----------------------------------------------------------------------------------•----------•-------------•------------------ ----•----- --- ---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ - I hereby that•1 have prepared this lication and tha+ + work will be done in accordance with San Joaquin County ordinances, a la s, and rules d regul �ns of the S Joaqui Local Health District. -- --- ------- --- �,. / Contractor) {Signed} ... . .. By:-------------------------------------------------------------------- -------- -- - -- --- --- (Title}_� - (Plot, plan, showing size of lot, location of system ' a+ion to wells, buildin s, etc., can be pla ed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY - --- - -------------------------------------- DATE REVIEWED BY----- ------------ ---------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------- ---------------------------- ------------------------ DATE----------------------- ------------------------------------- Alterationsand/or recommendations:_-- ----------------------------------------- ----------••------------------------•--------- ---------------••-------------•-------------------••------------- -----...--•----------------------------- - ------------•-------------------------------------- ------------- -------------------------------- -----------•-•-------------- --------------------------------------------------- ------------------------------------------------- ------------------------ ----- ------------ -------_------------------------------------- ------- -----------------------I------------------------------------- ----- FINAL -----•----- -- FINALINSPECTION 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 ES-9-7M 145446 ATWOOD 12-54