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so 1 APPLICATION FOR SANITATION PERMIT Permif No. _2 ----------- (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. JOB ADDRESS AND OCATION-----------1l�-5-------------- ------- Owner's Name. ---------------------------------------------------------------- Phone--------- -------------•---_-•---- Address � Contractor's Name-.___-• -. --------------- Phone. 4' :9d . Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -,/--_ Number of bedrooms _..Z—Number of baths --.--I Lot size ---------!__Its-------X./-----------------` Water Supply: Public system •[Community system F1 Private ❑ Depth to Water Table _40 ft. NI Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jg__H a rdpan ❑ Previous Application Made: Yes ❑ No �3_ New Construction: Yes jd No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ Distanc e trfrom foundation16.-r_---------Material ----.........__ _ , --- No. of compartments--_-_-_ -_-_-__-._ Liquid depth --•- `t ------- Disposal Field: Distance from nearest well__e4/&760 f7istance from foundation- ___-Distance to nearest lot line_ ...... _. Q Number of lines------------ ___________Length of each line_-_------��--� Width of french. ,r j� ��----•- - Type of filter material___,1�------�Q[ ._. .Depth of filter material----!------------Total length------- --------------•------ �� /� � Seepage Pit: Distance to nearest well.-__NDistance r foundation----lf __n-_-__.Distances o nearest lot Number of pits.____..._._...._____Lining material =� s.Size: Diameter_-,--?__-2.......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) ------------ ------ -•---------------------•------------------------•---••----------------------•-•--•-------------------------------------------- -•------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------•------------------------------------------------•-•---•...---•------•-----------------•---------------------•----•--•---•----------••--------------- -•--•---..... ----•--------------------------------------------------------------------------------------------------------------------...._.--------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws and rules and regulations of the San Joaquin Local Health District. (Signed)- .... .. 0-7-21--k-1----------------------------------------------------------------(Ow er and/or Contractor BY•- -- -- --- ---- -l�--�---_ - -- - - `----••----- ----------•---fTitlel---- -- ------------1----•------- --- -------------- (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----s REVIEWEDBY------------------------------------------------------------ -- -- ----- ----------------------•---•-------------------- DATE------- BUILDING PERMIT ISSUED------------------------------------- ---- -- DATE-.------------ `�� _-___________ _______________ _ ------- ------------- ------ Alterations and/or recommendations-------------------- --- ------- ------------------------------ ----- --- ------ �--------------------------------------- ------------- y C --------------------------------- --- ---•-- -----------------------------------•-----------•---•--•--------------.---------------------•-•- FINALINSPECTION BY--------------------- �.�,5------------.--------------------- Date------------------------- -•---• ----•--�-----------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 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