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r G APPLICATION FOR SANITATION PERMIT Permit No. -�1-- .�---.. (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. This application is made in compliance with County Ordinance No. 549. 3 ,-o5 ". C�6-C ------ airNC-------- / s JOB ADDRESS AND LOCATION.. -------- Z fes'- -------- r Owner's Name__e_l- =--•----------- 'Y�n _. 1 - - T-- "Rhone._R ;•471F-•------•- •------ ----- ------------ Address-- `. Q ---•-•------•----------------------------------------------•------------------•-••----•----------• Contractor's Name-_,,:Z -A-- _ ------ -----------------------•---------------------------- ---•-------- Phone------------------------------•---- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j_____ Number of bedrooms ---/__..Number of baths .I----- Lot size ___ - --'t---��- --�---------------------------- Water Supply: Public system ❑ Community system ❑ Private L� Depth to Water Table _6A_ ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 21 Previous Application Made: Yes ❑ No ® New Construction: Yes 0 No ❑ TYPE IOF,INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} - ` .- ° .....Distance from foundation----/d__-t--___.Material___- '"� ------------------------- Septic Tank: Distance from nearest well--,'7'No. of compartments Z Size -------Liquid depth--=----./------ ---Capacity----�pa---------- Disposal Field: Distance from nearest well_-_-?0_-____.-Distance from foundation___Z:P________-Distance to nearest lot line___ar:._______. ® Number of lines-------- -•----------------- --Length'of each line------ "F4-.------.Width ofrench_-__;�:Y-`-------------------- Type of filter material_t ------ ____-Depth of filter material_.,_J_4P- ------Total len th__.._. _______________________--- -N Seepage Pit: Distance to nearest well-.__� )--------Distance from foundation__�5�.--------Distance to nearest lot line----S---------- Number of pits----_-/_-_____-___Dining material_/ir&€ .___ _-__-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____________ --- -------- ❑ - Distance ,� :r . — r ____ __________----- Distance to nearest lot line--- - --------------- ----- -------------------------:----------------_--__------------- 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. -. ..--- ..� r ---- ---------------------------------------------- ------(Owner and/or Contractor) (Signed) _ J --- * Sy:------------------ - -------------------------------------- --------------------- {Ti+le) {Plot plan, showing size of lotjocation of system in relation to wells, buildings,a+c., can be placed'on reverse side]. L- FOR DEPARTMENT-USE ONLY I APPLICATION ACCEPTED BY- --� •-•---------------- DATE---�� 'r REVIEWEDBY------------------------------------ ----- -- ------------------- ------------ DATE------------------------------------------------------------ DATE PERMIT ISSUED -------------------- r = DATE --..---..._... Alterations and/or recommendations:-_ A --_-�---- -------'. -s•r.�-----�s '-... '`.� 7 - .------------•-------------------- -------- _- . " { ,� ------------ i f ---------------•- ^� ---- - ------ -----• --_--______ ----. t FINALINSPECTION BY------------------------- ------------•---- Date....... ------------ -----------------•- -------- ----------------•----------- 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