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t ,X' APPLICATION FOR SANITATION PERMIT Permit No .. {} j•� (Complete in Duplicate) Q , 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 Countyrar Note �JOB ADDRESS AND LOCATION (T(�" --.....Y� 1�0f1 f.N..'N� Owner's Name---- •. -•............. Q.----- _ Phone---------------------------•-•--•--- Address................................ ..................... Name......60-A1.4/9_4 V1— .............................. Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial x Trailer Court ❑ Motel ❑ Other ❑ Number ounits: _2--_ Number of r n4 ---I--- Number o .-Z-- Lot size ......... k ©d Water Supply: Public system, Community system ❑ Private ❑ Depth to Water Table .' _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam° Clay Loam ❑ Clay ❑ AdobeR Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if��pu``blicsew��er is available within 200 feet.) Septic Tank: Distance from nearest well__!Kty4aU�istance from found tion.....,/?_.....Mater-aj.- No. of compartments--___' _-Size-----_X-_ lC.,, .Liquid depth....._-�__----___-Capacity.......---....-Q... Dispos I Field: Distance from nearest well--. -4-Sistance from foundation....../.�_-_._..Distance to nearest lot line.��-•-. Number of lines.______._._/__ __________ ______Length of each line_...__..._747..........Width of trench--------Z�___...._....._.. Type of filter material___._ epth of filter material_________�2.._._.Total length................?J-______-•___---_---J Seepage Pit: Distance to nearest well _/yy"-__.Distance o f ndation..../_0 Distance to nearest lot�line:__ Number of pits-----/-------------Lining material_.. .. ize: Diameter.....�Z� __-___--.Depth---2 �: _......... 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 line----- -- ----------- --------- ------- ------------------------------- ----- ---• --- ------------------ Remodelin and/or repairing (describe):-------------------------- _ its .............. _.-1_d- ea, --Q`-Qhrti--....--�.C..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 law d rules and regulations of the San Joaquin Local Health District. (Signed -----. -Owner and/or Contractor --------------------------------------------------------------------------(riifle)------------•--------------------------------------------------- (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 ff REVIEWEDBY... ---------------------------------------------------.._.__..__ ..... DATE BUILDINGPERMIT ISSUED----------_-•-------------- -- --- --------------------------------------------------- DA,E----- ---------------------------------..................... Alteratio and or recorn ndations_______________ __ ---------_-----_..__.._.__.. ............... ............. ----- c f✓41 2•P •�- ------ . -- -- -- -- --- -"=�------'f� ...................y---------------------.... 3 ._..._� r - --- ` 9-6- �----- ---- FINAL INSPECTION BY------------- -...``i--..... -.t``# ' ° Date. ------------------------------------------- SAN -------- -------- -------------... SAN JOAQUIN LOCAL HEALTH DISTRIC 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