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= APPLICATION FOR SANITATION PERMITo . Permit No. .__��. (Complete in Duplicate) ' Date Issued - V/11__�_ 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 County Ordinance No. 549. JOB ADDRESS,,AND LOCATION.-_- -4"'—_ .,%Y//- 1 � � r •• -fit �-- --•-------------•---------------- --• ---------------- -------------------------- Owner's Name--1j.-y1v__.__AA ¢--_ff4A_, 14,4 ; "'� --- �--------------- - Phone Address �fi ` -- •lJ-- � ---------- --------- ------------ --------------•------------- Contractor's Name- -_- >� . J- -- 7- ---------. --- k --'-------------------- -------------------------------------------- Phone Installation will serve: Residence a[f Apartment HCot k Y menouse ❑ Commercial ❑ Trailer Court ❑ M � Number of living units: ---�_- Number of bedrooms __X_ Number of baths J_ Lot size ----- ._ f,. l ❑ Other ❑ f Water Supply: Public system ❑ Community system ❑ Privatepepth Ater Table -------- ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ®� New Construction. Yes Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer as available within 200 feet.) ` Septic Tank: Distance from nearest w•eli�-------- -DistapGe from fwDoation-r-0 _ at rial----- -------------------------- S ' L/( . .�d =. No. of.compartments /, tize r� r .-. Liquid depth 3 � I Capacity- c jll-y�, Drati -, . f sthcet�enh e s} lt in Disposal Field:• Distance Number oInes - ength of each line �� , --- Wdfre - . �_______ �� f ----- --------------- Type r filter materia`�1 � , --- epth of filter material--- -------------Total length---- ---f �f ____------___-- Seepage Pit: Distance to nearest well---------------------Distance from foundation-------------------.Distance to nearest lot line---: ElNumber of pets----------------------Lining material-----------------------Size: Diameter-----------__----------Depth---------------------- .---------- ---- ---------- 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-------- ------------ Remodeling and/or repairing (describe)------------------- -----------------------------------------------------------•----------------------•------------------- ------------------------•---------------------------•------------------------------------------------ --------------- ---------------------------------------------------------------------------------------------------------------------------- . "----------------------••---------------------------------------- I hereby certify+at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe laws�and rules and regulations of the San Joaquin Local Health District. 1 (Signed): - �• r:-w_- .-_ ------------------------------------------------------------------------.(Owner and/or Contractor) gy-------------------------------------------------- ---------------------------------------- ---- ---------------------------- - -----(Tif le)--------- -•--- -- ------------ ------=-- -- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -FOR-DEPARTMENT-USE ONUY— APPLICATION ACCEPTED BY` - .-------------- --------------------------- DATE REVIEWEDBY------ ----- `-- --- -- -------------------------------- ---------------------------------------- DATE - cr' BUILDING PERMIT ISSUED--.--.-------- ----------------------------------------------------------------------•---------------- DATE - Alterations and/or recommendations----------------------------- " --------- �'* -----------------••------------------------------ ----------------•------------- ------------- -----------------•-------------- ----- ••------ •---•-------------------••---------- - -- - - --------- ---- --------------------•-- ----•-------------------------- ••----------------------------------- ---------•---•--------------------------------------------------------------- ----- - - - ---- - --- - -- - I FINAL INSPECTION BY-------------------- ------------------- -- ---------- Date----------I�--'a�--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 4 North "C" Street Stockton, California Lodi, California Manteca, California Teacy, California E5-9-2M 145446 ATWOOD 12-54