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-p; APPLICATION-FOR, SANITATION -PERMIT Permit No. (Complete in Duplicate) .» Date Issued _-!rl---.. ._-- 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. JOB ADDRESS AND L ATION______________ -------------- Owner's Name ------------ --- - ------------ - -------- -- ------------ ---------.. Phone-- " Address------------------ Contractor's Name...---, ------ Phone Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ =otel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms --,L Number of baths .1----- Lot size --•-----•--------•- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay [] AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No"W New Construction: Yes K No ❑ `- 4 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(&'_(_',_Distance from foundation--/.0------------Material -_-.�.� No. of compartments....... ------------Size_:-.. Y— � --Liquid depth_----``-----------------Capacity Disp al Field: Distance from nearest welf_,_2j.d-,I p�istance from foundation-----J. V__.-.._Distance to nearest got line.--- ---.•_ Number o{ lines--- `Ya�,�,r-------------- ength of each line---_./ --------- _Width of trench---AJC--- �- Type of fitter material_ e f filter material.-_.19--"___--_Total length-----�__�.._�-- eepage 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------------------------- Sze Diameter.._ . _ , -----------------.Depth_ ----------------------- ---- ------Liquid Ca acity ii� Privy: Distance from nearest,we.11..r -- -Distance from nearest building } -�- — : -� �_,..�. . 9 ----------------------- ------------------ ❑ Distance to nearest lot line...____........ �'*�-r -_ __ . - ------- ---- -----•-----1--- -- Remodeling and/or repairing (describe):-------- -- ---------- ----------------------------------•-------------•--- --- ---------------------------------I----------------------------------------------------------------------------------- T ------------ - ---- --•------------------------- •-----•----•---------••------------•----------•--------------------------------------- •---------•-----------------•--------------.---•-------••-..-----------------------------�_'th I hereby certify that I have prepared this application andaf the work will be done-in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -- ------------------ -----------------------------------------.(Owner and/or-Contractor) - By--------------------•------..-.-------•---------------------- --- - -------------------------------- -- --- ----•---- ._._Title __ Pot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........................ ---__--_-_-. DATE-___ �� REVIEWED BY �' ------ BUILDING PERMIT ISSUED--------------------------------- -te' r,. --------------------------Z---------------------- DAT/E- --------------------- f ( _t -- -Alterations and/or recommertdations:..______ _______________ ......�F ___.___/•- -• _S - — - � -- -.-- --------- --- - ------------------------------- - ------------------------------ --_ ------ FNA NSPE N sem- - - - -- - ---- ------ ---- - LL- ---�• " Date----- ------ ---- ------• --__Il.x.._ . ST • T ,(.vN,G 130 So06 American Street 300 Wes} Oak Street " 132 Syea re 5}res+ 814 Norte e#�-►,,,4, Stockton,, California Lodi, California Manteca, California Tracy, California 145446 ATWOOD