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APPLICATION FOR SANITATION PERMIT Permit No. ___ ..-!.._Z (Complete in Duplicate) Date Issued ____ ___�/SG. Appiica+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, JOBADDRESS AND LOCATION-------` ------- `? eke= ----------------------------------------------•-------•--------------------------------- Owner's Name-----------Z —--•----- 1 :_ Phone Address-------------- ------ ...�.----------------•-------------------___------------------.--------------------------_----------------------------- Contractor's Name- � . .c 2�E- ---- Phone. ..- dd Installation will serve: Residence [& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _.-;�'Number of baths __�___ Lot size ------- ��------- Water Supply: Public system ❑ Community system ,❑ Private 3 Depth to Water Table Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No g- New Construction: Yes 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-,5V. .__Distance from foundation----;4L?-_ -----Material _____- - - ---------- 10 No, of compartments-._-,, � _-_Size__ __X- _5,Ca__Liquid dep- h___-6-Q-------------Capacity-----s�dv------ Disposal Field: Distance from nearest well-,d!�-F-----Distance from foundation___- 0____-_.Distance to nearest loft Number of lines-----'---- -- Length of each line---::__�S _.---F�_-Width of french------�_44_---- ------ -- --ii---- Type of filter material _ -____Sf'L-Depth of filter maferial______ _ ________Total length------ _______________-______ _M.. _ rr Seepage Pit: Distance .to nearest Zell.-//o from foundation......go- ___.Distance to nearest lot line__`_ ----_ i� Number of pits------ Lining material_ __Q__/ �i�e: Diameter__--_�R_-------Depth------ ________________ Cesspool: Distance from nearest well-----------------Distance from foundation-- _-______-__-___.Lining material--.-----__-__-_-_-______-__-_________. ❑ Size: Diamefer-------------------=-------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: _ Distance from nearest-"well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest,lof line----------------------------•----- -------r- ------------------------ ---------------------------------------------------------------------- Remodelingand/or repairing (describe):.-------------------- k-------------------------------•-------------------------------------•-----------•---•------•--I. ---------------------------- --------------------••------- -------- -----•------•---------------------------------------------____---------•----------------•---------------------------------------------- •----••-•--------------- - I hereby certify that 1-have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State S. and rules and regulations of the San Joaquin Local Health District. y (Signed].. / �-- =� -------------------------------- (Owner and/or Contractor) By:--- --- ----------- �f"`r---- ------` -------------------(Title)•--•-----l ------it (Plot plan, showing size of lot, locationof system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------F---- DATE REVIEWED BY------------------------ ------- - DATE------------ BUILDING PERMIT ISSUED-------=- - - - -----------------------• ----- -•---•-- ------ DATE------ •-----------� --------------------------------------------------------------------- Alterations and/or recommendations_____________________,___- 1.�----•----------------------- .� _ -----------•--------- ------ --- - ------------------- -- - - -� -•- --- ---- ----- ------`---- - __---- - ....... ----------- - -: FINAL INSPECTION BY--------- - ---------•--------------------- -------'::------- ". Date----- ------- -----------J---- ---J---------5- - ---�----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "G" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12.54 S