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vc s APPLICATION FOR SANITATION PERMIT Permit No. __.PL ./.-_-_ (Complete in Duplicate) Date Issued ._. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and This application is made in compliance with County Ordinance No. 549. install the work herein described. JOB ADDRESS AND LOCATION--- - - - -- -------- Owner's Name---�`-•-'�/(-� Address----- ----------- ----fes _ _. n ` - - ------- --- - - - Phone--------------------- hone------------------------------------ ---•_-- ----- ,__-____ - - --- ------------------------------------------------------I----------------- Contractor's Name------------- 'r;_-• y__,r�"-� _ t_- - -------- -- -- ------ --- ----- -------------- Phone.....--------------. -------------- ----•--- ----• ❑ Trailer Court Motel ❑ Other E]-• Installation will serve: Residence Apartment House ❑ Commercial ❑ Number of living units: _- "-- Number of bedrooms -_ - Number of baths .-1-- Lot size -----Water $uPPIy� Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLJ4 Previous Application Made: Yes ❑ No El New Construction: Yes ❑ No E] oam Clay ❑ Adobe F] Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-_--------------Distance from foundation---- No. -..Material----------- r Na. of compartments.- - --- - - - -- ----- -------------------------- Disposal -------------- -- -----.. Di / Size---------- ------ -------------Liquid depth------------- ...Capacity ....................... Disposal Field: Distance from nearest we!1. ___.-------.---Distance from foundation_____-_.-..__------Distance to nearest lot line_________________ Number of lines------ ---------------- -- --------Length of each line----------.------------------- ..�` Width of trench.-_--__--___- / Type of filter material---------------- - --- ------ ............. Seepage p Iter material-- - Total length---..------------------------------------ Seepage Pit: Distance to nearest we!!__d1`�� c 4s.:- D stanceffrom,foun ation-..-*4'-------.Distance to nearest - d Number of pits. p lest lot Ime_---i`---- --- -------- ---Lining material_(1_ Cesspool: �" Size: Diameter ,." rg l Depth_ '✓-- - -------- Distance from nearest we!I--------- -----Distance from foundation- ___ --- . Linin material__.- ��• ❑ Size: Diameter.------ Depth - - ------------ Privy: Distance from nearest weN-.. .--_ N _Liquid Capacity---------------------- -----gals. .._ ❑ Distance to nearest lot line__ m ------------------- -Distance fronearest building----------------------- _ _ .--- _. ,--___- _- _ "---- -- ------- - Remodeling and/or repairing - } �C_s_ __<._ti t c--. - _-------------------------------------------- ---------------------------------------------------------------------------------------------------------- ----------------" ----- ------ -- • ----•---------------------- --- - - 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)---------------- - -- -- F f {Title) -,.:. � ,� C or) {Plot plan, showing size of lot, locatipfi of system in relation tells, buildings, etc., can be laced n p oreversesi"de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. __.-.-_- REVIEWED BY------- • ------ DATE - ------------------------ -e,----- -"------ - ---- ------------------------------ ---- ILDING PERMIT ISSUED DATE- -- ------------------ -- -------- ------ ---------- - ' - • -- Alterations and/or recommendations:_-._- _ DATE__....------ _. -- -- - ------------•------------------------------------- -------------------- ------ •--------•--- - ---------------- -------------- --- ------ - -- -•-•---------- --------- ------------- -I-- ------------------ - ---------------------------- FINAL fNSPECTION BY:..... .............. 11 --------- Date- �. - � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 131 Syeamoro Street 814 North "C" S}reef Stockton, California Lodi, California Manteca, California Tracy, California ES-g 145446 ATWOOD