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LA � r APPLICATION FOR SANITATION PERMIT Permit No. ..... 7_� J�`' (Complete in Duplicate) Date Issued Thi Applica-lion is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549' . JOB ADDRESS AND LOCATION_. __ _.dC,.- ----------No-------------� r , __... j, ----------- ------ -----•--------------------------------- Name_,�/��- - ,' -•--- Owner's ------- _ ---•-------------•-------- -- - ------- . Phone..---•------------------------------ Address -----------•---------------------•------------------------------•--------• --------- ------------- Contractor's Name_____ ___ _____� •-• ----- ---- ___"-- ,p Installation will serve: Residence [4---Aqaartment House ❑ Commercial ❑ Trail'er Court ❑ Motel ❑ Other ❑ . Number of living units: ---L Number of bedrooms .2L. Number of baths -_-I_-- Lot size ----4".0_----,�("--2_��--------- ---•---"---- Water Supply: Public system ❑ Community system ❑ Private A--Depth to Water Table VSO ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ Previous Application Made: Yes ❑ No en-ttew Construction: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi yank• _ Distance from nearest well-----------------Distance from foundation--------------------Material ___. __- -_ No. of compartments-- ------.1---- ----------Size------------------- -• ---•----------------- • - - • -- Liquid depth--------- ----- ------- Capacity-------==---- --------- Disposal Field: Distance from nearest well-.' '. Distance from foundation___._ ._.._Distance to nearest lot line___ ---- Number of €fines_._.___-_______ ._ Len th of each line_____- __ a t 9 7. ------.---- .Width of trench-2--9--11--- ------- T e of filter material �. ---------- Yp --------------Depth of filter matenaL.__.��_..__-_._..Total length--____-;rd=___:_: l� Seepage Pit: Distance to nearest well_-y/ - rom foundation____ 4 i __. ._____.Distance to nearest lot 1- L_f�'^-- Number of p�ts__-�.___- --- Lining materiaLe A'Z,-<._ .Size: Diameter_{, `if < r - ---- -------- Depth---�'.- ----- Cesspool, Distance from nearest well--------------- —Distance from foundation___:_,-_____._.__--,Lining material_----__- ❑ Size: Diameter----- --------- --------- -------Depth----- --------- ---------- -------- --- ------Liquid CapacifiY---------•------------------gals. p Privy: Distance from nearest well..-.-__----_---------------- -----;-,-----Distance from nearest building--"------------------ •---------- ❑ Distance to nearest lot line------------------- ---- ------------- ----------------------- --------------- . ------------------------------- ---------------- Remodeling and/or repairing (describe):----___..-------------------------- ------------•----------------------------- ------------------- ----------------- ------------------•----------•-----------•---------------•-----•------------•----------•----------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed).--- - ------------------- ---------------------------------------------------------------------- V Contractor) ----------(Title)-------------------------------- ............... �r [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--_.._____REVIEWED BY _ ..... - - - ----------------------------------------------------- DATE-------- ----- BUILDING PERMIT ISSUED _-_--- -- ----------- ------------------------------------------- DATE `- - -------------- DATE ..... -----•------------------------- -- Alterations and/or recommendations:--------------------------- --- ---- f \1 •----•-------------•------------ .. = --------•-----..._.. -- ---- ............ - - - -- -- ------------------- - ---------------- F1NAL INSPECTION BY::__--_-- :-- • .. .--•-- ----- -------------- --------- Date.----�-�---C--�--y --------------------------------------- SAN ------------------ •-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes# Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California 145446 ATWOOD 1z 4