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APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) (� Date Issued .71K/5-�___ 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. JOBADDRESS AND LOCATION---'---- -.--"-�-'�--':-.�i�`-='------�,=-�-=--F==-=�--:..::------=----`--------------------------------------------------------------• ••---- r jk Owners Nam i.--- _- 11---�•-�,- yj ----•�--_,;--�•--•-�`--�_-=----r._.__-�.�-� _._..--•-•-------------------------------------•--------�-------------------------------------------------Address Contractor's --••--•- Name____ff_;_.4 ... ..__ .-_. f x__.. __.r__.__ r ' ./ _ f�t,� �, � ?��!�.��--=-,--�.�-�.�,,,,®�--=-------- - •- •- --- Phone-----------•------•------ - ---.. .._. - •- ---------- Installation will serve: Residence,KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4" Number of living units: __/___ Number of bedrooms . :_._ Number of baths __f-__ Lot size .- - -t,_?__._-_____•_______________________ Water Supply: Public*system Community system ❑ Private ❑ Depth to Water Table . -ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.Q Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes,] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1, # Septic Tank: Distance from nearest well__---- ----------_Distance from foundation-------------------Material-___-_-_.._.-_-_-_.-______________.._____-._____- o :(� No. of compartments--------------------------Size_...--------------- Liquid depth..........................Capacity----------------------- Disposal Field: Distance from nearest well.............._..'Distance from J.-r'd-afion-----------------. -Distance to nearest lot line_-__-_-_---______ Number of lines-----------------------------------Length of each line-------.----------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length----------------.------------------------- � Seepage Pit: Distance to nearest, ------ from -oundation_ % �+:..Distanto nearest to li _. �' � Number of its.-.:____ -__Linin materialL.j�tr'� ---Size: Diameter__Z" Depth--- '._. ---- Cesspool: 9 Cesspool: Distance from nearest well-----------------Distance from foundation------------��inin e __.__.._______.___-.___--__--____- _ ❑ Size: Diameter---------------------- -----.Depth------------------ - ---------------=-....Liquid Ca ity- --------------- ----------g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-------------------------.--------------. ❑ Distance to nearest lot line------------------------------------ �--•s--------------------------••------•-�-- ------------------------------•------- 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).....JF_ � >r a_--C�%. _.._ = - -------------------- -------(Owner and/or Contractor) ------------- r _!- ,� I By:- ��' = ---`1Sz ,741_-T,<•c—----------------------------------------------'-----------------------(Title)--, �,�_ - ' 1 - -�---_--------------- (Plot plan, s owing si ` of lot, location of system in relation to wells, buildings, etc., can be placed on revessre side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --- - --- ---------- --------------------------------------------------- DATE--- = REVIEWEDBY-------------------------- -------- -------•- ----- ---- - --------- - ------- --------- ----------------- DATE--- BUILDING PERMIT ISSUED-----••-----•- ------ - -- - ---- DATE---------I��------------------------------------------- Alterations and/or recd endations;_._.- ._._ - --- - `----- - �� ------------------------------------- ------------- 7:/�� ------- -------------------------------------- 'FINAL INSPECTION BY.--------- - ------ Dater 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 E5-9 145446 ATWOOD