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APPLICATION FOR SANITATION PERMIT Permit No. .-_ - -3 (Complete in Duplicate) 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 County Ordinance No. 549. °^ C203a-- U 1 - JOB ADDRESS AND LOCATION...._. — ---- ---o_ ----- ------ ----------------- Owner's Name- Z' --• - ---- . ---- Phone-------- --------------------------- ------------------------------------- Address �1f�- ---- ---- - -------- .. ----------------------•-----------•--------•-------•-••---•------------------------ Contractor's Name 1llL, r7�/Y ---------------------------------------------------- Phone----------------------------------- Installation will serve: Residence _Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:__-- Number of bedrooms _- Number of baths ._ Lot size ----.14d------ /_Z_Z�p------------------ Water Supply: Public system *Community system ❑ Private 5�Depth to Water Table .f.577t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J Hardpan ❑ Previous Application Made: Yes ❑ No 0- New Construction: Yes � No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi setwer is available within 200 feet.) Septic Tank: Distance from nearest well--_- - p stance from foundation_-- ---------Material-- _---------. ] No. of compartments-----9..............�Size.at .- -lZsl iquid depth...-_��Z-------Capacity----1 Disposal Field: Distance from nearest well. +stance from foundation---/,.: . -....Distance to nearest line-- ---_--._ N Number of lines--------- Length of each line--� _ --9X� Width of trench.-_-------- S <I--------- i 1 ------ ---------- Type or filter material.__ -Sk-Depth of filter material--- - ------------Total length-_1;;2-79-__------_-------_----- Seepage Pit: Distance to nearest well___-------------------Distance from foundation_----------------- Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------•------- Cesspool: Distance from nearest well-----------------Distance from foundation._---------.--------Lining material --_-___------.------_----_----_----_. ❑ Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid Capacity----------------------------gals., qti Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____--_.--.--_-------__----_--_-.-----., ❑ Distance to nearest lot line--------- --------------------------------------------------------------------------------------- ------------------- � : Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------------------._-----------------5 r ----------------------------•-------------------------••---•-•-------••-----------------------•------••-------------------------------------------------•-----------------------••----•---•------------------ ------------ ------------------------------------------------------------------------•-----------------•---------•-------•--------------•----------------_......----------------------------------------------------------------------_ � I - ------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------•----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfj ordinances, Sfaf , and rules and regulations of the San Joaquin Local Health District. {Signe - (Owner and/or Canfractorf. BYt�--�•-�-�--=�-f-.�.�-T- - ---- - -- - {Title----- :-•--------•--------------------------- --�i (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-V-------------------------------- --------- ------------ --------- ----------------------------------------------- DATE._--•-•- ---------------------- --------•----------- REVIEWED SY---------------------- --- - - ------ DATE;-------------------------..- BUILDING PERMIT ISSUED-------- -------------------------------------------------------- DATE.---"q7s---------•---- ----------------------------------- Alterafions and/or recommendations:------------------------------- --._.-8`-..-._-_-----.--..-._---.--._--.- ------------r...... ......r.----•----------------------- ------- �►�. c�J �✓ -- -------•el-•-•----- r . . itis �;. .� - ---- . f -- - C LQ-' ! i!rS �4�-L - _.r. --- V r r _ �l F - f� -' --` �J� FINAL INSPECTION BY:----_`'!^„'. -•-------------------------------------._.- Date . ---- g.8 ---------------------------------•-- --------- 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 E5-9-2M 145446 ATWOUD 12-54