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�1y APPLICATION FOR SANITATION PERMIT Permit No. - -��-5 __-- (Complete in Duplicate) / Date Issued ---.-�,l..y�r 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. '� �j] JOB ADDRESS AND LOCATION-- -- _- .!� �- °� i (2 Y��` V Owner's Name---- ---- ------ - ---- ------ -------- Phone.-.------------------- Address------------------------ - ------------- Contractor's Name------ --=-----------------------------------•-------- Phone-/1 _.5.7 /G_..- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: /---- Number of bedrooms -3-. Number of baths -�-- Lot size ------ -- -----de�-__.Q�,�•_,_------__-_------• � Water Supply: Public system ❑ Community system [❑ Private JZ Depth to Water Table 347 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [❑ Clay ❑ Adobe [❑ Hardpan ❑ Previous.Application Made: Yes ❑ No New Construction: Yes No ❑ r 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-.'Y.....--___Distance from foundation_- --4.---------.Material__----'--._`------------------------------- j ( No, of compartments-_----a2----------------Size-SI _-_-, cS' - -___Liquid depth---- ---Capacity.-�-aha- ----- Disposal Field: Distance from-nearest Distance from foundation__ Q- -------Distance to nearest lot line_:--- s r J Number of lines-----1----- -------------- Length of each line----7�_---------------Width of trench--_. -----------------_----- ». Type of filter-material-___� _. _._-_---Depth of filter material--,/,?- .------..Total length----7 ---- Seepage Pif: Distance to nearest welIJ t----Distance from foun ation-y3_C-?_"_--_.-.Distance to nearest lot line_.�-1 Number of pits------ _-------------Lining material gl41--- -- ize: Diameter....,R3------..-___Depth......R29 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--------_-___.__--.---.---__-----_- : -❑ :.r . - 5ize:rDiameter-----_- ------=---------------- Depth-------_--------------------------------- ------------ Liquid Capacity gals. -w �. - Privy: Disfance from nearest well-_-.---------------------------------------------Distance from nearest building-----------------------------------------. ; ❑ Distance to nearest lot lire.:..-.-____....................... Remodeling anti/or repairing (describe)------------------------------------ --- -------•-----•-------------------------••--------•------ ---------.---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- ---------------------------------- -----•-----------------------------------------------•--------------------------�- --------------------------------------------------------------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �( ordinances, tate laws;a d rules and regulations of the San Joaquin Local Health District. _ ..;�-(Signed)---- -•--------------- •- -------------- -- ------ -------i 00-------- r Can � /} -�a. racBy ..--•-------- !1 ----Z.,1 �X'lam ----- -------------------------------------------- --(Title- - -, ---------- (Plot plan, showing size of lot, location of Pem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY----------- - ------------------------------------ ' ----------------------------------- DATE----- .5~ REVIEWED BY - - --------- DATE � r26- -------------------- --------- BUILDING PERMIT ISSUED ---------------------------------- --------------------•-------------------------- •-- ------------- DATE--------------------------- Alferations and/or recommendations-------- ---------- - - - ------------------------------------------•-------------------------------•--------•------••- -•------ - --------------------------------------- FINAL INSPECTION BY:. Date-------- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+rest 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California E --g-2M 145446 ATWOOD ,z-sa