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APPLICATION FOR SANITATION PERMIT Permit No. ... - l (Complete in Duplicate) Date Issued ... /--` �e--- 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. o.�------ �- .. �r l's--------- JOB ADDRESS AN LOCA I N___�� -- - �F - j� --- Phone------------------------------------ Owner's Name__c.�•f�_ e- ------ Address ---. CSC/--- •----•- --- Address-----------------�_--- -----------�.-----------•-----------------------------------------------•------------------------- Contractor's Name-------= 1P_ �.� -1 1V�' - ------------ Phone----------------------------------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___l__ Number of bedrooms _-- Number of baths __._l_. Lot size ------ ------ -- th to Water Table Water Supply: Public. system ❑ Community system El Private �� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 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.} i Septic Ta k- Distance from nearest well-J-0---__-Distance from foundation--.1d____..---.Materal____ ---- --- 1 LiL-_____.. r !� No. of compartments-.._....�-------------Size__ '-.--- ..�C a�--��--•---Liquid de�h----- -- ------ ------ Capacity------ -----............ Disposal •eld: Distance from nearest well__,_/ -Distance from foundation_ d_._...._Dis#ante to nearest l-1ie__ ..______.. Number of lines-------------�-- --- Length of each line------1.4---a--1177------Width of trench----=�_,-------------------- pII Type of filter material- /'_�__..._.- -_Depth of filter material___.__ ___.___--Total length______13_____________________J___.._ �-_.___.Distance to:nearest lot line----- Seepage ___-�._- 0 (�--_.___Distance from foundation__-_____ _ _ See a e Distance to nearest well... _______ P g -�_ ' ,,f mry_^ 4 :Size: Diameter___ �.. Depth-r- -Lining {umber ofPits-- ---- -1---f---------•-- }\� �) Cesspool: Distance from_ earest well_________________Distance from foundation._..,---.__._____Lining material____.._.___-,______________-_-_____. De th-------------------------------- ------------------Liquid Capacity_------------------- gals. Size: Diameter----- - -----=-- --- ------------- P V� ❑ - -- ' �. ---------------------------- = Distance from nearest building-----------_-----------•---------------- Privy: Distance from' nearest well❑ Distance to,nearest lot line-------------------------- --=----- -------------------------------- ------------------------- Remodeling and/or repairing,5 des��ibe): '" .'- - .---�-n" �} ________________________________ ___ ere ____ _ ___ _ ____ ____ _ ___ _ ____________________thi__ __ ____ __________ _______________________ ___------------------------------------------------------------ ________ _ _ ______ ___ _ ________ ______ I hby certify that I have prepared s application and that the work will be done in`accordance with San Joaquin County ordinances, State ws and'rulei'�anol"regulations. of the-Sari Joaquin Loea7'Health District. -------±-----. ----------------------------------- ---- r Contract (Signe .. --_/��_S_�L_..-- -------��-"-------- ---. caner and/or or) {Title) ----------------------- By:.......... (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------ '. ------------------------------------------ ' - ------ ----------=------------- -- REVIEWED BY----- ----------------- DATE---•---------------•�----------------------------------- \ BUILDING PERMIT ISSUED--------- ------------------------ --- --- DATE_. Alterations and/or recommendations:____-_-- --- .•------------------------ ---- --- - --------••---------------------------------------------------------- ----------- -------------- - - ------------------------------------------------ -- ---------------------------- --------------------------------------- - FINALINSPECTION 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 145446 ATWOOD