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r APPLICATION FOR SANITATION PERMIT Permit 11.v�._ �J (Complete in Duplicate) ; 9' 4a Date Issued ..._. )Vjz. 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 LOCATION..--?/ ---------------------------------------------------------------------------------------------------------- ------- �_��/ �n�---------•-------------------------------------------------- --- Owner's Name........ r �� !S/ e --------------------------------------- ----------------------------------------- Phone------------------------------------ Address----------=----- mac`.... _------------------------------------------------------ •--------------------------------------------------------------- •--------------------------------- Contractor's Name------ i9!P J` ------. ---------------------------------------------------------- ------- Phone----------------------------------- Installation will serve: /Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f__ Number of bedrooms .___ZNumber of baths ._..Z_ Lot size ---------/-------1P.-C e!�____--_-_.-_-._-__-_ Water Supply: Public system ❑--tommunity system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3--Hardpan ❑ Previous Application Made: Yes ❑ No Ug—"New Construction: Yes [E �o ❑ 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-----------------Distance from foundation....................Material------------------------------------------------- ❑ frS71N� No. of compartments-- _--------- ---------Size----_-------------------------Liquid depth------------------ -------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation-----------.........Distance to nearest lot line................. ❑��((-1(A-.4 ' Number of lines-----------------------------------Length of each line----------.----------------...Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material........____------Total length.......................................... Seepage : Distance to nearest well_W!:�_e Distance from foundation_,kP.O../....Distance to nearest lot line__ --/- Number of pits--------l-----------Lining material----�r/'.C_X.Size: Diameter.___,3•.�.`.°--------Depth._._.,-23._/________________ 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---------------------------------------------------------------------------------------•---------•------•-------------------•-----------•--- �q/4/i o n/q LD Remodeling and/or repairing (describe) ......------ ...------.. /P/9 i /V---------•----------•-•--------------------•-----------•----------------------•• ----•--•-••--•--------------------------------------••---•------...--•-•--------•-----•---------------------------------•-- -------------------------.----------------------------------------------------- ----------------------------------- ---•---•----------------------------------------------------------------------------------------------------------•-------------------------•-------------------------------------------- I hereby cKIs have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Starules and regulations of the San Joaquin Local Health District. RfA/ iC(Signed)------------- - ------ ----- ------ -- -------------------------------------------- ----------- ( er and/or Contractor) --------------- - - By:--------- - --------------- - ------ ......-------• -----------------(Title)--- (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--------------- ---- -- --- ------- ---------------------------------------------- DATE------- _`------------------------------------------- REVIEWED BY DATE - ` BUILDINGPERMIT ISSUED----------------------------------- - ------------------------------------------------------ DATE----- -------- ,/ --------------------------- Alterations and/or recommendations---------------------- ------ --- --------------------•---------•-------------•--------------------•.------•--------- r4 -----•---•--------------- . + ----------- --- - -------------------- ----........................---...........-................................................................ �� .......... •----------------------------------------••--.......--•-------•-----••-----------------................... ---------------- ------------ - -------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------- Q FINAL INSPECTION BY:---::!!!!9 --- Date---- �.--�--"------.5--- - ------------------------------------- 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 ES-9 - 145446 ATWOOD