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APPLICATION FOR SANITATION PERMIT Permi# No. ... . -�--Z (Complete in Duplicafe) � �� Date Issued --- ------------------ 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__<z`-00..-Q-."_ Owner's Name---- 2 �-,� ------------------------------- --------------------- ---------- ---------- Phone_..---------------- Address----------- -- ---- ------•---------------•--•--------------•---------------•-------------•-------------------------------------•-------= ----------------------- Contractor's Name_.._D_L t?��c 1••-.•- --P------------------------------------------------------------------ -•------------•-----------•-•------ Phone-------------- --------------- ----- - Installation will serve: Residence A artment House Commercial C] Trailer Court [) Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms _fir._ Number of baths j______ Lot size Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table --------.ft. I, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan ❑ Previous Application Made: Yes ❑ No P;�r New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within•200 feet.) S ptir,Tank: Distance from nearest well_________________Distance from foundation____.___.__.-___ th : Material ---------- -------------------------- �X '� No. of compartments-------------------------Size--- --Liquid depth---------------- --------Ca Capacity[ P Y -------------------- i Disposal Field: Distance from nearest weli.__c -----"-Distance from foundation---)-Q__---------Distance to nearest lot of each line___��-- -- �---- �.._�_._� r line__-�-�.---- Number of lines____.;L-___________ ___________Length 9 l . -.Width of trench_-. Type of filter material_ V.k_±G 4h of filter material-_19 -.---Total length b------- -�-------------•------ ----- a GVptr ma I Seepage Pit: `Distance to nearest well _ __.- _ :---�_Distance from foundation_______ _________ Distance to nearest lot line___- , Number of Pits Lining matenal_- ------.:.Size: Diameter---------------------- Depth------------ ---- --------------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material-------- - ❑ Size: Diameter------------------ -- •- -- - --------------------------- Si g: Depth-- _-------------------------- ----------------------Liquid Capacity- ---- -_-- :gals:--IN - Privy: Distance from nearest vrell__ '------------------------- _.._.-Distance from nearest building._---"- Distance to nearest-lot line__.__"______'._.__ `�''�- -----------------------------------------' Remodeli and/or repairing (describe):_._ ' --• -- �d�Ge�� :• - .------------------------------------------ -------------�--------•---•------•--- ------------------------ --------•--------------•-------------•-------------------------------------•----- •------------• --------------------•----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws nd rules and regulations of the San Joaquin Local Health District. (Sign ed)_Iw - ------- _ -- ( / yf � -- - - -- ------------------------r------------------- -------- --------------- -----Owner and/or Contractor) BY:---------- -•------------------------------------------------- Title _ - -------- ----------------------------------------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ----- --- ------ DATE.______ -------- --------------------------------- ED BY -- ---- -- ----------- - ----------- -= ----- DATE----- -- ------- UILDING PERMIT ISSUED - t t, -------------------------------------- Alte tios and/or recommentrons: DATE----------------- = -------- r -------- -------- �'•� . ..... ..Tj - --- - - - .-�-�._--- - --' s ---- -- - r --' --u-�- -f�. ------ •--- -_ FINAL INSPECTI BY:.. . ------ ------------_------ ---•-- Date----O----- --- _1 =-"-------------------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef 1 Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9^"2M 145446 ATWOOD 1Z-54