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APPLICATION FOR SANITATION PERMIT Permit No. ..Q..O-. f j (Complete in Duplicate) w. Date Issued ___ � Applica*ion is hereby made to the San Joaquin Local Health District for a permit to cons ct and install the work herein described. This application is made in Compliance with County Ordinance 549. JOB ADDRESS AND LOCATI N__.--- _�- ------- A ;Owner's Name___ -- - G Phil ------------ ----------------------------- JP ------- Contractor's Name----- ----- - •------------------------------- --------------------------------------------------------------- Phone----------------------------------- Installation -------••--------------------• •- Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court.❑' Motel Other Number of living units: Number of bedrooms _umber of baths ---I--- Lot size -- -- "'^-- ------------- -------.----------- w Y r Water Supply: Public system Community system ❑ Private ❑ Depth to"Water Table3-6-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ�Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.)t[' Septic Tank: Distance from nearest well�xf_�1�.�•�Distanc from foundation__.' _D--------.Material-- --- - ----- No. of compartments---,, - _ ..--..._..- -Size- -_ ---A j 1 quid dept ---- -_-.-- Capacity------ -- _- Dispo Field: Distance from nearest wel W-^L Distance from found _-�- ation. 0-----._Distance to nearest i t line---_-S -------- L Number of lines---- r4 ,- -'_---- L th of each line-_-1-_ _____-:-----Width!of trench...� �— Type of filter materi - - ---- er material_-_...1�f.j�--.--.Total length--------1_-- ,- :. . Seepage Pit: Distance to nearest well.-_---------------------Distance from foundation--------------------Distance to nearest lot line-.----------_--._ � ❑ Number of pits----------------------Lining material------------------------Size: Diameter----------__-. ---------Depth ------------------------------- Cesspool: ------------Cesspoo : Distance from nearest well-----------------Distance from foundation------------------..Lining material---------------------_---.-_---._----- ❑ Size- Diameter----__----------------------------Depth----------------------------- ---.-----------------Liquid Capacity------------------------- gals. VPrivy: Distance from nearest well-----------------------------`--------------- Distance from nearest building-------------_--------- ❑ Distance to nearest lot line--------- -------------/ ------------------------- w Remodeling and/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, State laws, and rul s and re ulations of the San Joaquin Local Health District. (Signed)... ------ ----------------------•-------------------------------------- ---------(Owner and/or Contractor) By:. 4 •----------------(Title)----•-- --------------------- ------------ ------------- (Plot plan, showin size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). rr N FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - ------ ----- ------------ -------- -------- ---I—. DATE----------- REVIEWEDBY--------------------------------------------- ---- - --------------------------- ---------------------------.:....... DATE------------` �/• BUILDING PERMIT ISSUED - DATE ----------------_ Alterations and/or recommendations:.-.----_-------- ---- - - - ----------------------- S --------• --------- - -- ----- --- -- -------------------------- --- -- --- �•---F. ---- ---_--------- �'`' ............•-----------------••---------------- ,t FINAL INSPECTION BY: ----- 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 E� 9 145446 ATWOOD