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U it Permit No. .... ......... APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued _____________________ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ti This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND jLOC TIONra2 3-�C' -. --------.�Z---------- `. I=t --------------------------------------------------------------------------•--------- Owner's Name.... /__r, a ---------C, -A r ---------•--- ---------------r---- - ------------------------------------- Phone---%�i` C may° �------- Address---------------3--A"IPm--....----- --------------------------•---------------------•-----------------------------•------------------------------------•----------------------------------------- Contractor's Name.- �._A.R.i,4.A �%� � ' -------------- ------------------------------------------ ------------ Phone---- `17- Installation will serve: Residence EE—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/__ Number of bedrooms ____L Number of baths ___/__ Lot size _ __-___, _ �`__ __ _________________ Water Supply: Public system ❑ Community system ❑ private []-oTSepth to Water Table f_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ 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.) -l__Distance from foundation_ ._ - Septic lank: Distance from nearest well_,.K-__-_ T ` �.... - ,l•Q-------.Material__��_G-�___ __•_/��. _____. tJ No. of compartments------_��------------Size___�_�--�.-�4 -- ---Liquid depth-- ----- `3 Capacity---- -----�------ Q Disposal .eld: Distance from nearest well__,, f --Distance from foundation-----4C_�....Distance to nearest lot line __._:K-- Ile Ar Number of lines---------------% ; Length of each line_______� ----Width of trench--------- : - ________�__ Type or filter material----_ rDepth of filter material__.._-C�.r.-___Total length_______._�_s.�'-�______________________- -N Seepa it: Distance to nearest well_10A---------- Distance from foundation__-__ ---- Distance to nearest lot line------------------ Number ____ ________Number of pits------%-------------Lining material--///- -Size: Diameter__:-r.----____Depth----- ______-___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_._______..________._______________- 0 Size: Diameter--------------------------------------Qepth----------------------------------------------------Liquid Capacity------------ -------gals. Privy: Distance from nearest well ._.__.__-_____________________________--------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line------------------------------------------,-------•---------...----------------------------------------------------------------•---------------- Remod ling and or repairing (describe):-------C j /f'c"--------- �•.<.-- _T_-Ps j� E ---- . w i O T ,� ------•-- --N ---------M't--------------------•------•---.------..-----------------------------------------..------------------------------------------------------------------------------------------- ---------- -------------------- --------------------------------------------------------------------------------------- -------•---------------------------------............. ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statt ws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ---------/-------} �7 ---- j - -- - -------IO .er and/or Contractor By------ -.4 � ..... ----------------------------------(Title)- -- ------•---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverst side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------- ------------------ ---------------------------------------------------- ---- DATE- ----4 -- ---------------------------------------------- REVIEWED BY------------------------------------ ---- -------- DATE -------------------------------- BUILDING PERMIT ISSUED------------------------- ------- DATE------------ --------- Alterations and/or recommendations:-------------------- -------------------..-------------------- ------------ - ---------------•-------- --------- �� ----------- --------- ----------- - -- .--------------------------------------- -------- - ------------------------- ------- --------------- -------------------------------------------------------------- ------------------•----------------------------------.-._.... ---------- - --- -------- ----•------- ----------------- ------ FINALINSPECTION BY---- ------------------------ Date.---------- ---------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Proof 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California £5-9-2M 145446 ATWOOD 12-sa