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GLH/0-10a' APPLICATION FOR SANITATION PERMIT �ermit No. -_..�__��_G•g_ (Complete in Duplicate) _ - g Date Issued •_.f_" __-_ --- Applica4-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 inSccoom lianncce with County Ordinance No. 549.6577 " Q�r / y JOS ADDRESS AND CATIO N ----- -------------------------------- -�----------- -- 1 Phone Owner's Name----------�-,---- ---t------ Address----.....---•. ------ ------- -------------------- --t. a------ 00 ------/ --------• ............... Contractor's Name... ' --------------------- - Phone Ev�hQ-l7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other E]Number of living units: __�__ Number of bedrooms __ I�fumber of baths -____ Lot size _____ ------`__�_._.> I&--____________________ Water-Supply: Public system ❑ Community system ❑ Private LR[ Depth to Water Table A;?o-zft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous-A Iication�Made:-zY-es' ]—No- --New Construct.ion.:>`Yes:- No- Q w TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellJ_ _'Distance from foundation_.&_-� Ma/tterial----&G - <------------- lid No. of compartments------ - :---------Size--_ -- -- �=..Liquid depth------ .......--__Capacity__,.V ------- t i --_.` Disposal Field: Distance from nearest well-6--mo�_)--._Distance from foundation-----/0._/......Distance to nearest lot line._-..�- Number of lines------------- �� 7 Length of each line______ V-- --------.-.Width of trench........ -----------` Type of filter material___ __ ------- _?_r-5✓Cr Depth of filter material_....-Zy---------- length- ---��•---. Seepage Pit: Distance to nearest well------------------------Distance from foundation--------------------Distance to nearest lot line________________• ❑ Number of pits----------------------Lining material---------------------_-Size: Diameter-.----------------------Depth----------{- ---=---------_•--- Cesspool: Distance from nearest well-----------------Distance from foundation------__.-- Lining material------------------ _----___:_____ ❑ Size: Diameter-------------------------------------Depth------ ------------------------ :---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 1j'i^1 ❑ Distance to nearest lot line- ----- Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------__------------------- -- .............•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------•-•---------------•-----------------------------------------------------------------------------•--•-•----•--- ------------ -----•------------ - --------------------------------------------- ------------------------------------------------------------------------ ------------------------------------------------------------------------------------•----------- _--------. 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} C4/ Y -- - ��--1 -- -- -----(Owner and/or Contracior) By; --------:(Title)------ �sr�. (Plot plan, s owing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------_------------------- DATE-_------ - - REVIEWED BY. DATE -----�'-I----------------------------- .- . . BUILDING PERMIT ISSUED------------------------------ ------ DATE------ --- --------------------- -------------------------- A,Iterations and/or recommendations:------- -------------------------- ------------ ---- -------------- •---•-- -•----------------•----------------- ------•--------------------------- ------------------------------ ------ -------------------------------------- ---------- -------- -- --------- ---------- ------------ -----------------------------------------------------------------------•----------------------------------------•.-••-• -------------------------------------------- ------------I-------------------- -------•-------•------------------------------------------------------------ ------ .......... -- ----•--------------------------------------------------------------- -----------------•----------------------- FINAL INSPECTION BY: �Z Date-....- �. --�� r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD .z,