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APPLICATION FOR'SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __(_Q�f f S~� l: 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 LOCATION-------------------------- v =---- .. Owner's Name------------•-••--•------- ------- ---------------------------------- --- .... Phone------------------------------------ Address--........... ----------------------------------- Address.............. r` --�--------------_---4�P .,-— Contractor's Name------------------ �. ---------------------------------------- -------------------.--------------------------------- Phone--------------------------------- Installation will serve: Residence k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J___ Number of bedrooms --!7—Number of baths _/_____ Lot size D_----- I } ------ -_- Water Supply: Public system X Community system E] Private E] Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ - Previous Application Made: Yes [] No 4 New Construction: YesfijT No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l - A.(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from ,nearest well-----'"___.Distance from foundation____ -------- .Mate ria_- '.t'{-'---- ----------, No. of compartments---------� ---_--::Size------ - - X_� _---Liquid depth--------- -- -- ------ --Capacity Ca y------ d ----- Disposal Field- Distance from nearest well.-.°�------_Distance from foundation______..__._..Distance to nearest lot line._____ ..._. Number of lines------_------ _----_ -___Length of each line-------------- -�?-------Width of trench------------- -` - --------- Type or fitter materiaf-. 1 C ©epth of filter material_.__._.1.P.--------Total length_______________________� ________- j Seepage Pit: Distance to nearest well ______---_-----------Distance from foundation-_.......___........Distance to nearest lot line_-__-___________ k ❑ Number of pits-----------------------.Lining material-----------------------Size: Diameter-----------------------Depth----------: ---------------- t Cesspool- Distance from nearest well----------------- from foundation.-_---- __--------Lining material----------------------------._________- ❑ Size: Diameter---------------------- ' •• ...Depth------------------------------------------- --------Liquid Capacity------------------- gals- 1 Privy: Distance from nearest well___ -.._`'"-----------------------------------Distance from nearest building--------------------------- ___--- k ❑ Distance to nearest lot fine--------- -------------------•--- - ----------------------------•--------_----_-----=------•------------ -------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------- ----------------- -----------•------------------------------•-------------------------- ----------------------------------------------------------------------- .. ------------------------------•------ -----------------•------------------•-------------------•----------------------------••------------------------•------ ------------------------------------------------------------- I hereby certify that I have prepared this application and tha+ 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). d By:---------------'.----------------------0----•-----------------------------------------p---- --- 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 =-----•----------------------------- -------------3 i------------------ ------------------•-------------------- DATE BUILDING PERMIT ISSUED---------- ----------------------------------------------------- ------------------------------------- DATE ------------- AI ations nor recommendations- -------------- - ---------------------------------- ------ - - -.__ ___- ------- ------- ._ _ _ . -_y_-___.__ t -' -----------------•-------------------- r4`--• pry • / ------------------------------------------ - --- ------------------- --------------------------------- _ G - f -s FINAL INSPECT] N 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 12-54 ,