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Z, ~ V APPLICATION FOR SANITATION PERMIT Per it No- _-_-.�._ (Complete in Duplicate) �j 1�� .f »> Date Issued _______ ___ _____ Applica*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!!C''ounty Ordinance No. 549. JOB ADDRESS AND LOCATION,---J--_�YR ec.--------- --------------..-_---------------- iOwner's Name---•------- ------ -------- ------------------------- ------------- Phone-------------- --------------------- Address --r---------------------------------------------------------------.....--•---------------------------- -------�------------------- Contractor's Name------------- 1 _`__� � V, Installation will serve: Residence �"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /__ Number of bedrooms .--2'Number of baths .--,1-- Lot size ----54_'X j 47r-------------------- Water Supply: Public system T" Community system ❑ Private ❑ Depth to Water Table _Vr_Tf. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P-lHardpan ❑ Previous Application Made: Yes ❑ No P____New Construction-. Yes ❑ No +[ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearest well--;______________Distance from foundation--------------------Material--------------.-----------.---------.-----.-----. No. of compartments---------------------__Size--------------------------------Liquid depth------------------------Capacity------------------------ D' ps .field: Distance from nearest well-__.......- ----Distance from foundation---------------.----Distance to nearest lot line----------------- Number of lines-----------------------------------Length'of each line---------------------.--------.Width of french----------------------------------- Type of filter material--------- ._..__Depth of51iferla',1',l-----------------------Total length------------------.-------------------__-. Seepage it: Distance to nearest well '`' ------Di ncen--_3�_.______.Distan�e to nearest lot line-�_'�_-_--_. J(� Number of pits------ -------------Lining ateriaiC : Diameter-_.-.3;'_ ......Depth-----.'z '� _.-__Cesspool: Distance from nearest well------------- --Distanceion.-----------.__-_._ Lining material--..---..--_--__-_--------....-_----. 10❑ Size: Diameter------ -----------------=------------ Depth----- - ------ ---------------Liquid Capacity- ---_-----------------gals. Privy: Distance from nearest well-- .---------------------- ----------------------Distance from nearest building-._--_-__.----..-__---_-----__-----_-.-.-. 1'fl ❑ Distance to nearest lot line--------- ------------------_----- -----------•------------------------------------------------------------------------------------------- � Remodeling and/or repairing (describe=-------- --------------------------- -------------------------------------------------------------------------------------------------- -------- � F -----------------------------------------------•-------•--------------••---------•------.------------........--•--•--•-•---------------••---------------- ---------- 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, end.rules and regulations of the San Joaquin Local Health District. r7 p d.0 -�-----_ t r (Signed) — _.___._-__. _ .�--___- . _ __(O . er and/.rContractor] By:...... �L, --- ---- ----r---------------------------------------------------------------(Title -- -- . (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------•'---------- DATE......... `---------- --------------------------------- REVIEWEDBY-------------------------------- ----- ------ --------- ------------------------------------------------ DATE------ -------,�- ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------- --------------------------------------------.----- DATE..-............. _.. ------------------------------ Alterations and/or recommendafions: - --- --Q_1-------------------_- -------•----------•-------•--••------------------------•-•--•--------- ---- ---------------------------------------------------------- ------------------------------------•-- ------------- ---------- ---------------------------- ---------------------------------------- --------- ---•--------------------------•--------------------........I--------- FINAL INSPECTION BY:--- �/ Date....-- .- _ --'-- ---- ------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West'oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M 7 145446 ATWOOD 12-54 ' r