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F, APPLICATION FOR SANITATION PERMIT Permit No. ._ ..----•- (Complete in Duplicate) Dc,e_lssued 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. _________ - ---- ----- -----*2t> JOB ADDRESS AND LOCATIONh Owner's Name_____ ------ ---- one-------------------------------•- -- _ _ - e Address----- --------• -------- - ------------------------------------------------- ------ -------------------------------•--------------- - -------- Contractor's Name------ --------- C ...(, - - ------- -- ontracion will serve: Residence ] Apartment House ❑ Commercial A Trailer Court ❑ Motel E] Other El InstallNumber of living units: __._ Number of bedrooms -------- Number of baths -------- Lot size Water Supply: Public system ❑ Community system ❑ Private �S Depth to Water Table _boft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobea Hardpan ❑ Previous Application Made: Yes ❑ No 2- New Construction: Yes ❑ No P�-- TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public 1w eer js_av-ailable_within 28Q feet. f Septic Tank: Distance from nearest we11-_;___�.P_.._Distance from foundation-----`0.___.._.Material______-Cl�- C------ No. of compartments---------;P . --------Size-_--f --, L`__Liquid depth.----/�,-0-----------Capacity------�� _-6------ / I Disposal Field: Distance from nearest well----;--'.{t.____Distance from foundation-___ 1----.--Distance to nearest lot Gn Number of lines--------------1 --- Length of each line--------- ms`s-Q----.r Width of trench------i+Z ------------------- Type of filter material__�_�---✓rF�7-Depth of filter material- �_�_.---------Total length--------/-Q`d------------------------ Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line______________.__ ❑ Linin material-----------------------Size: Diameter--------------------- -Depth- --------------- --------------- Number of pits---------------- -- - g Cesspool: Distance from nearest well _____________---Distance from foundation------------------- inmaterial -- Size: Diameter-- ------- ------------ ----------Depth-----------------•-- --- - --- Lqing�Cap ls El � . yir Privy: Distance from nearest well------------------------ ______------.----Distance from nearest building_.._._----.___._________-.____.._____-- ❑ Dista - - ---•------------------ nce to nearest lot ine--------�-- ---- ---- -- - ----- ----- ---- -------- ------•-- ------------ r s Remo eling and/or repairing (describe):_____...- c__ ----- ------ ------ - - - ----------� , ------------•-----••----•--------------------- -------------------- -• - --------------------------------------------------------- -----------••--------•------------------------------- ----------------•-------------------- --------- --------------------------- ------------------- -------------------------I--------------------------------------------------•----------------------------------------------------------------------- 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. ~ -4----- - ---------------------------------------------------- - (Owner and/or Contract [Signed}. --------- -- - ----- -- ------ --- ---- - --- ----- -By-=--------- -- 9 p (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc., can be laced on reverse side). FOR DEPARTMENT USEn ONLY APPLICATION ACCEPTED BY�_ ----•----------•------------- DATE ---------------------------------------------------- -1 -----------------------------------------------..._ REVIEWED BY------------------------- -- DATE BUILDING PERMIT ISSUED-------- - ------ DATE. = - Alterations and/or recommendations:_.................... . ------------------- ------- -------- --------------- -----------------I---------- ------------------- --------------------------- - ------- ----------------------` ---------- -------------------•-------------- ----------------------------------------------------------- -------------•- - ----•----------- A.- Dae_..-_- ----f ;-- ------------------------ FINAL --- --- FINAL INSPECTION BY:....... ___....f -`.-- 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 ES-9-2M 145445 ATWOOD 12-54 -