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APPLICATION FOR SANITATION PERMIT Permit No. ._ _o-_----... (Complete in Duplicate) d Date Issued Applica*ion is hereby made to fhe.San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ?with �County Ord-Hance No. 549. �f JOB ADDRESS AND LOCATION Vtl- -.-.-.. ��_ �. 4'tvc-"L' �/ i Owner's Name---- ---. -• ------------------------------------------------------ ------ Phone...---------------------.-.-.:.---- Address_� .. .- . ,��=' ---------*�� q � ---•----------------------------------------- -`--- •---------•--••--•• Contractor's Name----------------------- ---'�---tit Phone_,/9'�P..!�-9�07 ---0 ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other [I Number of living units: -------- Number of bedrooms -------- Number of baths . -- Lot size ------------------------------------------------------------ Water Supply: Public system E] Community system ❑ Private Er"*-Depth to Water Table 3 ft. Y Character of sail to a depth of 3 feet: Sand ❑. Gravel [Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ 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 feet.) Septic Tank: Distance from nearest well--'S -t-Distance from foundation_---/!�..........Materiel__5ze,-- --- _----- _ ` No. of compartments...... - ------------Size--•-S 6 --2- - -------Liquid depth...... Caacit �---------v--- --- Disposal Field: Distance from nearest well_+`_Dfrom foundation__..-G-$-.---.Distance to nearest lot line----- -,e / Number of lines---------�--...- ______Length of each line---140-0..------------...Width of trench-.- 2_5o..+----------------_ Type of filter materiaLSi G l!- ..-�['--Depth of filter material-------/,?. -,._-Total length-----ZOO------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_-_-.----.------.-_Distance to .nearest lot line--.--_---------. ❑ Number of pits_--------------------Lining material-----------------------Size: Diameter.----------------------Depth--------------------------------- Cesspool: Distance from nearest well----_----------Distance from foundation------ ------------ Lining material -.---_--------.--.-___-------------. ❑ _ Size: Diameter--------------------------------------De.pth___-.-..__--__ ---------- -Liquid Capacity-, als Privy: Distance from nearest well---------------------------------------------- Distance from nearest building____.---__---.------.----_-_----.------. ❑ Distance to nearest lot line.................... -------- -------------------------------------------•----------------------•------------------- ---••-------------------- 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, St la!ws,.and rules andregulationsof the San Joaquin Local Health District. _ -.-.- .--- wne ` (Signed)-......---. -------------- -------------------------------------------------- - - - - - - �O rand/or Contractor] ---- -------------------------------- ----------------- ---- ! /.0 L �' --------------------------(Title)--------------- ------------------------------------------- - (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 / - REVIEWEDBY------------ ---- --------� -- ------- -------------------------------•------- DATE-'' --•----------•---------------------------- BUILDING PERMIT ISSUED. .......... ----- DATE ------------------------------------------ Alterations and/or recommend ations------------------------------------------------------------------------- ----------------------- ---------------------------------------------------------- ---------------------------------------------------------------------------- ------- -------- ----------------------------------------------------------------------•---• ---------------...-------------•-•----------------- ----------------------------------------------------------------------------------------------------------------•-•-•------------------------------------------------------------..-..------------------------------•-•-- ------------------------------------------------- -------- --•-- -• • ------------------------------------------------------------------------- ------------------------------------------ -------------------• -•--------- ------'--------- ---------^r ---•'`�" =--------------------------------------------------------------------------------------------------------------------- �•,,,,,,.� - ---------- FINAL INSPECTION BY: -- --- ------------ bate------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9 145446 ATWOOD b