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\Q� , \ J, �_j � . . - -- APPLICATION -FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date Issued -----�?. Applica;ion is hereby made to the San Joaquin Local Health District for a permit to co truth and install work herein described. This application is made in compliance with County OrdinanceSNo.'a549. W �3�' 'uJ f Gin+s ..J r4 ✓rC. / _/ JOB ADDRESS AND LOCATION Owner's Name.`: .'__ - . -:-- ��=�•� - --.. -�� - . Address Phone Contractor's Nam e______. mac. "- - ---------------- -- phone. Installation will serve: Residencep A artment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: __ "" Number of bedrooms - -• ❑ Other ❑. Number of baths` Lot size __"� f Q Water Supply: Publics stem ,��.� "" PP Y� Y A �.ommunit system Y ❑ Private ❑ Depth to Wafter Table .�,,fT f#. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam fay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No U' New Construction: Yes gD—No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welf__ "_?t!G i - _ l�stance /from foundation__._/0•-------Mat ria)--,- No. of compartments--- --- ---------------Size__el - •--- -•----- • � �� Liquid depth f � .f Capacity_. DisposalField: Distance from near st well_ - 4?=7 pistance from foundat,}on._ _-_ -------p'stance to nearest lot fine_--�•--•,--•---- ®'" Number of lines, -"------ --- ! fine of each line_4?-- .,:_ 4 Width of french- Type of filter material- � epth of filter material----.__ .�""" �� Total length _Ilklk,.- --- ' -------------- Seepage Pit: Distance to nearest well----------------------Disfance from foundation__________________".Distance to nearest lot line______._________ Number of pits----------------------Lining material-.- Size: Diameter_-... Depth. ----------•-•--- Cesspool: Distance from nearest well_________________Distance from❑ - foundation______._----- Size: Diameter----- --- ------- ----_---,_-----------_D-.-epth----- --.Lining material-------------------------- Privy: Distance from nearest well ------------•---- - --- - � ----•-Liquid Capacity-----------------------------gals. .. ..---- -"-_Distance from nearest buifding--_---_--------------------------------- 4 _._-_--_ ❑ Distance to nearest lot line_--"__- --_'_-___.___ .t --•---------------- -•----•- ---------- Remodeling and/or repairing (describe):--- 7 " aJ ---------------•------------- ----------------------------- •---•-----..-----•--•-•--•---•-•------•---••------------ l s- ------------------------------------ -------- ---------------- • fhi a -application - a t ---•---•-------•-----"---------"---•-------------------•-------•-----•--•---•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County l� ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- �.J r -- -- -- a*4/e�Contractor). { gY� ••--- Aw ' 1 A� (Title) Pot plan, showing size of lot,,! anon of system in relation to wells, buildings, etc., can be placed on-ieverse s�e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- REVIEWED BY -.--_-. --------------•---- -------------------------------------- DATE"----,1 ..` . ----- -•--------- ------- - - BUILDING PERMIT ISSUED ------------------------------------------------------- DATE-----------'�-------------------------------------- -- - DATE------ - Alterations and/or recommendations: . --- "- ----- _________________ -------- --------- - f..--- �' < f - ----------•------------- - ._...- 1 _______________ - ____.______ ,___-___. ______________. ___________________________-________-._______...______ -- FINAL INSPECTION BY ------ Y�---- ----• --•----- - - �------ Date__.------/.� �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oefr Street 132 Sycamore Street $14 North "C" Street Stockton, California � Lodi, California Manface, California Tracy, California E5-9 145446 ATWOOD �t