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APPLICATION FOR SANITATION PERMIT Permit No. _..?_z. .. . (Complete in Duplicate) Date Issued pplica�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 com li rice with o n rdin a No. 549. PAA . r ` JOB ADDRESS AND / 1 — --------- --------------`------ --•---•----•-•• ----------------------- ..---- -------- -------------- Owner's Name = `--- ----�:� � ------ /-Y- Phone .e Address----------------------- --•-- x- Contractor's Name------------------------ s ------------------------------------ Phone................................... Installation will serve: Residence PVApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_.___ Number of bedrooms __Number of baths I____ Lot size ________________ Water Supply: Public system ❑ Community system ❑ Private Z, Depth to Water Table _600 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe DO Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_•:r_r-___Distance from foundation___—.............I�ateriaj--- _----------------______________________ No. of compartments______f/':_____ -____SizeSy36_'_'A�___Liquid clepth__-5__�._._________Capacity__$�OQ_-GAL, Disposal Field: Distance from nearest well,$.$--_.-----Distance from foundation__/�__-_______-Distance to nearest lot line_ . -� C4Number of lines----&.-Y --— Length of each line___-1;e40-______________Width of trench----------------------------------- v Type of filter material__------------- -------Depth of filter material-------------_.___�----Total length__________-__________________..._____..___ h Seepage Pit: Distance to nearest well_��____-_____Distance rorp fQf�ndation__ �__.___.D'stappe to nearest lot line ___._ Number of pits-��_-------Lining mate ria l_!)PIA- _-Size: Diameter_---yj-----------Depth-_- ------------------ - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-________________-___________- ElSize: Diameter------ ------------------- -----------De th----------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well-------_______-----------------------------------Distance from nearest building-----._______-________________-__________. ❑ Distance to nearest lot line-------- -•-•---------------------------------------•------------------------------•-------•-----•------------------------------------------- Remodeling and/or repairing (describe)_________ ______________ ____--_-___.________ - - --- ----------• •--• ------------------------•--•---•-••-----------•---------•-----•------•-- - ---- -------•- --- '�—r ----•--- --- -----•-----•-------- ---- •-- -------•---•-- I hereby certifjfh a3prepared thi application and the the work will be done in accordance with San Joaquin County ordinances, State laand@regul ons of the San Joaquin Local Health District. Si ned __:_______ ner and or Contractor By:----•-----•-----•-•-•----•--------- - --- --- -- --- ---- ------ --- - ---- -----------(Title)----------------- ---- ---=�--#----------------------- (Plot plan, showing size of to, location of system in relation +o ells, buildings, etc., can be placed reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- -- ------- ------------------------_-------------------- DATE--------- ....................................... REVIEWEDBY------_-_------------- -------------------------------- ------------------------------------------------------------- DATE___----------- BUILDING PERMIT ISSUED--------------------------------------- ---- .. DATE---------------- - ------- Alterations and/or recommendations:_-_----------------------- -�_�,_------------------------------------------------------------------------•-- -•-------------------- t -- -------- i ----- - --- ---- -• ...._----------- _j FINAL INSPECTION BY:.____LaLs=- ___________________ J Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54 -