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APPLICATION FOR SANITATION PERMIT Permit No. o`...... (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 Couni�dinance No. 549. ` JOB ADDRESS AND LOCATION... ..��.- ------- 5_. C£�-C�'.[..-42 � � --------------- Owner's Name-------------, ..- one................................... Wn Address----- ----.(l�_Q_r.., C..... ------------------------------------ -------------------- --•------- •---•--------•-•- Contractor's Name............................. ..........................................................------- ------ .................... Phone................................... Installation will serve: Residence 0AAp�artment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other 1; Number of living units: .._._ Number of bedrooms A'' Number of baths . _.__ Lot size©s._t -.�s?Q -_------_---__ Water Supply: Public system ❑ : Communitysystetn'01'�rivate ❑ Depth to Water Table ¢ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay 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.) Septic Ta& Distance from nearest well_---. _. ..__-Dystanc6 oundation .................Material-----------------------------------------..._.... 7" No. of compartments----- _ ize--------------------------------Liquid depth--------------------------Capacity-- .-..._.......... Disposal Fiel Distance from nearest well.�d�---_..Distance from foundation, .........*.......Distance to nearest lot.<line....15 ......_. ® Number of lines...............____ r, Length of each line----- __ .l f � Q_--•--------..Width of trench •�f ;� Type of filter material._�,� ;rk_.Depth of filter material-----/. --- ------Total length...... ..................... Seepage Pit: Distance to nearest well -_--. ------:Distance from foundation....................Distance to nearest lot line ............... 0 ❑ 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-------------..............._--_---__--. toneafe- lof line._..,_ 1________,.__%-- -, -------------------------------------- ----------------------------------- --------- --------- Remodeling and/or repairing (describe) -------------------------------•-------------------------- ------------.--------•----------•-•------------------•----- -- - --•- - ;` ---------------------------------------------------------------------------•--------------------------------------•-----------....-----------•----•----------•-----------------------•-------------------------------.....----5 -------------------------------------------------------------------------------••••-:�-•---•••-•--------•-----....--•---•-••--•--•-•----•--•-•-----•---------•-----•----••----•-------•--------•-----•-------- •-----•----- 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)4 , A`f. ---------------------------------------- ----------------------------------------------------------------------(Owner and/or Contractor) By--------------•---------.......----------------------------------------.------------------------•---•--•-----------------------------(Title)------------------------•--------------------------------------- (Plot plan, showing sae of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). DEP RTMENT USE ONLY APPLICATION ACCEPTED BY. ---- - ............... DATE.... D ------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE............................................................ BUILDINGPERMIT ISSUED---•--------------------------------=- •------------------ -----•---- DATE---------------------------------------------------- Alterations and/or reoommendationr. ...-........>- --------------------- ......... ----.. -..--•- -•----------------------------------------------------••------- --•- ••-•-------- --•--•---• -••..:..............................•---------...... -_... . . ---------.-. .... ..... ...--------•------- ...:..:------------------------------------------------ --------------------------------------------------------------------------------------------------------------•------------------ •-•-----•--------------••--- ...........-....................... _..-•-- FINAL INSPECTION 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' E$--9-2M 145446 ATWOOD 12-54