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APPLICATION FOR SANITATION PERMIT Permit No. --��°--�-----.--`�-- (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Loca4 Health District for a permit to construct and install the work herein described. This application is made in compliance with Count rdin ce No. 544. 1 ' -- --•-I---•----'------ ••-------------------------------•---------------- JOS ADDRESS AN LOCATION_ _. - �' Phone------------------------------------ Owner hone--- ---------•---------------------- Owner s e-- :..- ------•----- - -- �� - ` ____ / !•_ ___ _ E ------ --- _ ________________ ______________________________________________ _ ____________________ Address 4P----- -�-- ...-.__ ... w �'ti''�'`y - - --- Phone----••------------------ Contractor s Name-__ :.e+ --- ---•--• Mote! Other Commercial Trailer Court ❑Installation will serve: Residence Apartment House ❑ ❑_ Number of baths __'__._ Lot size __7-PIX-11.Number of living units: _��ommunity umber of bedrooms __-_-- W--- Water Supply: Public system s stem Private ❑ Depth to Water Table --_-__- ft.Y � Character of soil to a depth of 3 feet:' Sand E] Gravel F1 Sandy Loam El Clay Loam [I Clay ❑ Adobe Hardpan El Application Made: Yes ❑ .No � New Construction: Yes 1�No ❑ Previous App � TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if ublic�sewyer is available within 200 feet) -_----'Distance fr� f�nda n �----------.Mat rel -- -- ------------- Septic Tank: Distance from nearest well_,- ,�- Capacity �� - Size- - k x_ squid depth------ ----=-- ------- p Y---- �a, '-••- mpar#mems_.-__-- --- --- -- -- p I � . ._ Dis osal'Field: Distance from nearest well___. Distance from foundation.lgv*slance to nearest lot li fn _�' ,..-,�,.--�- --Length of each line------------ -� .-.Wic4th of trench.------- -' --- G�;� fflfNumber of lines___.__.._- - - � rr +r`^Ue th of filter material._._.__-.- ----.Total length------------- Type of filter maters �� o P Seepa �Plt: Distance to nearest well____- I' ----------Distance f om ndation__t ______.Qistan e to nearest lot !! --_--Lining mater' I� ..---Size: Diameter--- > ..-- --.---Depth.,..-_---- 4---------• ► � Number of pits....----l.-- -- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining materia_----_-------.-----.__.---_.__._.____ _r Li Liquid Capacity gals. ❑ Size: Diameter------- -------- --- --- -- ------pepth------------------------------ --------------------- q P Y----• ------------ --------- -_._Distance from nearest building-.___---------------------__.._--_---._ Privy: Distance from nearest well------ ----- it ❑ Distance to nearest lot line---------------------------- --------- ---- ------------•----------•---------- 1 `N-------------------------------------------- _----------•----------�i ---°---•----------------- Remodeling and/or repag (describe)-------------------- - ----- = " C -•-------- -------------------------- --------- ! *, ----------- -- -------------------------- ------------------------ I hereby certify th I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a law an rules"and rog ions of Joe n,Loca i,It istric# ------------------------(Owner and/or Contractor) (Signed),- t /`!?i ----------------------- r Tale 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 r DATES --------------------------------------------------- APPLICATION AEPTED BY- -------------------------------------------------------- C: _ DATE-- �' ' REVIEWED BY---------------------------- ------- ---- -- -------- --- --=--------------------- -------------- �-- BUILDING PERMIT ISSUED------------------------------ ---------------------------------- ---------- ---------•----------• DATE..----- - ------ --•------------------------- ------------ Alterations and/or recommendations--------------------- ------ -------- ------------------•---•--- ----•---------•-- -----•---•-•----•-----••--------------•--------------------- -------------------• - J � _ --------•--- f f --V ----- --------------- - ---------------- --- -----r ----------------- ----- --.... . 1 /' FINAL INSPECTION BY:----- ------ ----------------------------- Date--f-.J y---- � J --- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South Ameriean Street Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M 145446 ATWOOD