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APPLICATION FOR SANITATION PERMIT Permit No. -7 _!U... (Complete in Duplicate) �•� s 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 Ordi a e No. 549. JOB ADDRESS AND LOC AT O �,� Owner's Name- 4------ ----------------•-- ----------------------- ------------------- ------- -------- Phone Address------- -, - -r___ Contractor's Name -------------------------------------------------------------------------- Installation will serve: Residence gf-4artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f----- Number of bedrooms _-'--Number of baths - ---_ Lot size -_.--_.-x.--- J_ ---- ------------------ Water Supply: Public system nmunity system ❑ Private ❑ Depth to Water Table j-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Appiication Made: Yes ❑ No w Construction-. Yes ❑ No_d!�-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' *k-, Distance from nearest well_________________Distance from foundation-------------------Material--_______.__.__.__...-___._._.._____._-_______._. No. of compartments--------------------=-----Size-------------------------------Liquid depth----------- !.......... ..Capacity Dispo I Figj ; 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 of-fi}tef-material------_-- `-Total length--------------------------------•--------- Seepa Pit: Distance to nearest yre11 ►-E.,__Disfan�Mfaction- 4`�.-..Distance to nearest lot line----- ` -Humber of pits.-_.-/.-- ------Lining materialSize: Diameter__.{�� -_--Dept ----------------- Cesspool: - L ---------•--- }. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-____.-----_-----_----__-__---__--_-_. t ❑ 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---------------------------------------------------------------------------------------------------------------------------------------------------- I -------- -----------•-----------....------------------------------------------------••----------------•-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, d rules d regulations of the San Joaquin Local Health District. ' (Signed)------ --- By:--- -- ---------- --- ---------------------------__--------------------------------------(Title)--------------------------------------------- - ------------ ' (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--------- r REVIEWED BY --------------------------------- -------'-- --- --- - DATE------------------- BUILDING PERMIT ISSUED.--------------------------- --- -'- '--- ------------•-----'---•--- ------'-'-------------'-- -'-----• DATE._-------------- Alterations -- -•---- Y and/ar recommendations ------- -- ----- ----------------------------- ---------------------- . ------------------------------------------------ -- ---------------- -* ------------------------4q-.-- - _ -- ------- 'R ----------- - -------------------------------- -- ---------------' -----' ---- - '-----------' -/ ' FINAL INSPECTION BY-- ------ --- - - ------ Date.... -_ - - SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E3___9_2M 145446 ATWOOD 12-54