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APPLICATION FOR SANITATION PERMIT 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. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND CATION_---------- —------------------------------ -- ----------------"- --------------------- Owner's Name---- _ 4Z, Phone Address--------- - ----- ------------ Contractor's Name - Installation �-- ----------------------------------------- -------------------------------- ----------------------------------- �L._=�_ _s.- �.. •.-. ,®r------ Phonel�O---- -- -� Installation will serve: Residence g Apartment House [❑ Commercial F] Trailer Cos-rt ❑ Motel E] Other L] Number of living units: -------- Number of bedrooms --- -_- Number of baths -_/_ Lot size -_.,/ O-____ ---- _�- Wafer Supply: Public system [, Community system ❑ Private ❑ Depth to Water Table -.i0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pa__Hardpan ❑ Previous Application Made: Yes ❑ No Qj- New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well_-1 ."e3'L�^,Distance from foundation-.--. --_-.-MateriaL_�G �C.�_ No, of compartments.._ `" - -- - � l``.-�-� --Liquid depth_:s.��''_ . ------- Disposal Field: Distance from nearest well-.,LVC2il.�'scarce from foundation--_-!9' Distance to nearest lot line-,,A,) Number of lines-------- . .� ..___----Length of each line------.-1249. -----.Width of trench.--_- Type of filter material----1- -.--.-5/ilf.Aepth of filter material.-. -,---Total length--_-- j_�_----_----_ ,� / J - ----------- Seepage Pit: Distance to nearest well_ -Distance fro foundation_--&� ----p' to e�to nearest lot Ime-_t- /-- Number of pits___ .l___... -_ --- material- ste: 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 to nearest lot line- ---------- ---------_ --------------------------------- ---- -- - Remo ling and/or repairing (describe 1.� l c �---- ---- --------------------------------------------------- - -------------------- - -------------/---:-- -----------I-------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. - 5i ned _ caner------(Title)- --- -� and/or Contractor) (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - ------ ---- -- REVIEWED --- --------------------------- -- --- -- -- --- --- ------------------- -DATE. -------------=----------- BUILDING PERMIT ISSUED-------- ----- ------- - - ------------ --------------- ---- ---DDATE----- - .- ------------ ----------------- ----------------- - -- ....----- ----------- -- ----------------------- ATE---- -- --------------------- Alterations and/or recommendations------------------- FINAL INSPECTION BY: to"-- --------- ----------- ------- Date. / l '- .! ,.` --- .......... - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E$-9-2M 145446 ATWOOD 12-54