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APPLICATION FOR SANITATION PERMIT Permit N -1. -7--_- (Complete in Duplicate) 9/6 .-. • - Date Issued --------- Applical-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. rr- , JOB ADDRESS AND LOCATION------- .-.. Owner's Name--..-.. Address F� - QN /z f ones* - p --------------••------- -•---• -=-------------------------------- Contractor's Name--------- _- ;f /5&--------- C' =----------------- Phone.. -------------•- Installation will serve: Residence 1--Apartment House E] Commercial [:]' Trailer Court [3Motel ❑ Other ❑ Number of living units: -,-- --- Number of bedrooms -----7-Number of bathsLot size-� _ —� --:_. ..--- -- —------------------- -------------•-------- Water Supply:pp r Publicsystem R--c-ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam❑. Clay ❑ Adobe [>@Ffi @pan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E-_-Nd6'0 f_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: l Distance from nearest well------------------Distance from foundation-----------------=Material---_----_.-_.------_.---- --_-_- ❑f x �3Ti�t�No. of compartments...........- ---- ---Size------••---•------- Liquid depth------ -------- Capacity Disposal Field: Distance from nearest well_._-------------Distance from foundation-_---- _-----Distance to nearest lot line--_---------__-. ❑ G3`ry/l KJrNumber of lines------------- ------------- Length of each line------------------ -------Width of french. Type of filter material----- __------Depth of filter material----------- -----:_-----Total length------------------------------------------- Seepag P' Distance to nearest well./10-y,E"-__Distance frgm foundation-_--X .-'.-.Distance to nearest lot line-_,- �_/--- Number of pits------ --1----------Lining material-_-__ `C.--_ ize: Diam -_- eter .- v �. Cesspool: Distance from nearest well--------_----_.-Distance from foundation--------------------Lining materia l__-.-----------__---_--_----.-----. ❑ Size: Diameter ------------------Depth---•-----------:------------------------------ Liquid Capacity gals. �, Privy: Distance from nearest well------------- --------------Distance'from nearest building j ^l ❑ Distance to nearest lot line-------- -- - ----------------------------- Remodeling and/or repairing (describe):___.--__- - ----ft- ---------------- ----- p�J ---------------•-------•-------•-------------------•------------•-----•-•-----•----•-------------------------------------•------ ---- --------- -----------•------------------------ -----------------------••--------•-------:---------------•----•---------------------------------•-----------•-- - ----------------------------• -------------q-•-------------Y I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stat aw . and rules and regulations of the San Joaquin Local Health District.` (Signed) -----Ili --- 1 .S/� 1-7(f and/or C I i --------- .-. .(O rContractor) t -------- s Y By:.. -•----- •--•--------- -- ----- ------------ ------ --- --- -----_(Title) ------ ------------------ - (Plot pian, 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------------ ----- - -------------------------------------- REVIEWEDBY--------------------------------------- ---- -- - -- ------ DATE -------------------------- BUILDING.PERMIT ISSUED----- --------------------- -------------------------------------------------------- DATE----------- � = -� --------------------- Alterations and/or recommendation :--------------- - •------------------------------------ •--------- ---- - -- ----•----- ------ - ------ --------:�. : === ------ --- ------ - FINAL INSPECTION 'BY:-- -- - r -- - - ---------- Date- -- -- ---------------•- 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 ES-g 145446 ATWOOD