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APPLICATION FOR SANITATION PERMIT Permr lo. ----7,Z2_ (Complete in Duplicate) / Date Issued ---Jam--/�--.-._ Application 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__._S_7____-----11___.--, Q_�(----7_31--___-S T a C 4-70AlL ; Al __N_--_ - --------•-------- -------------------------- Owner's Name----V/- - 4-.----- __�1�!!�'S-------------------------------------------------- -- --------------- --------...--------- - Phone----•----.••----------------- - - Address.---------=- !qj Contractor's Name-------1!"--#_R_v_rk-------- ------------------------------------------------ -------------------------------------------------- Phone---�•-��---��-T-------• Installation will serve: Residence �—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms ___I-_ Number of baths __-j Lot size ---- �_ -1ZC H C� _ ------------------- r Water Supply: Public system ❑ Community system [I Private [t3.—Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3—Hardpan ❑ Previous Application Made: Yes ❑] No [- New Construction: Yes ❑ No EA:— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T kk:' Distance from nearest well_________ _ ________Distance from foundation______ ______-___.Material--------- ❑ I_"YiS�I�� No. of compartments------- - - ------------Size_------------------------------Liquid depth.------------iCapacity 1 Disposal Field: Distance from nearest well------ from foundation.__A..G_!----Distance to nearest lot line_-s7d_�-_- Number of lines_____________/._. -----______Length of each line_____-___---.4 .Q.�_.._.Width of trench._ _-�-..4r T.ype or filter material___f-�._____. _ ...Depth of filter material-------14_-----__-Total length-------- _a Seepage/Pit.- Distance to nearest well---1-44.1-----Distance f&o'm foundation--- . .____.Distan9 to nearest lot line_k3101' 101' s1E Number of pits..;-----/ material___ l _!_CzSrze: 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 build g ------- ❑ Distance to nearest lot line_ ------•--------- --- - ------------------------------------------------ Remodeling and/or repairing (describe:_________________ •------•--•-------------------•------- --••--------•------------------•------------------------------ -- r F hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and regulatio s of the San Joaquin Local Health District. ci(Signed)--------- ------------------- -- --- ----------- -- (O er and/or Contractor) ---- BY: ---- ---------• - -------- --------------------------- Title F ------------( � )---- P of 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-------- - `-._.__s- -------_ -------------- DATE-------- _ REVIEWED BY BUILDING PERMIT ISSUED---------------------- - ---- ''- - - ------------------ -------------- ---------------- -------- BATE------------- -- -_ -------•------- -----------•--- --------------------------------------- DATE-- --- ----�------��---- --------------- Alterations and/or recommendations:______...._-_._ . f =:------------------- f- ---------- Date FINAL INSPECTION BY:.... -- __-- '.._-2-7-J.P_-_�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54