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z APPLICATION. FOR SANITATION PERMIT Permit No. ,. > (Complete in Duplicate) / �ro 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 Co my Ordinance No. 549. JOB ADDRESS AND LOCATION....� Q ------ ..................................................... Owner's Name dp ----------------------------------------------------- --------- Phone.... ..Z._"" 2 1, Address._..._3 10 -- A9.41L �. Contractor's Name...... • A. ...................................------------------------------------ Phone 3 Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ z Number of living units: -1..... Number,of bedrooms ...I--- Number of baths ...._.._ Lot size <<SC1_____________ ............. Water Supply: Public system [Community system E] Private ❑ Depth to Water Table___ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Lo ` ❑ ❑ y ❑ y am ❑ Clay ❑ Adobe[[?""Hardpan ❑ Previous Application Made: Yes ❑ No N?" New Construction: Yes ENo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTa k: Distance from nearest well__;___-. -__--_Distance from foundation_.....___.:._.__._.Material__-________- No. of compartments----------- -- Size---_------_---------------------Liquid depth ---------- Capacity Disposal F eld Distance from nearest well-----------------Distance from foundation_________________ Distance to nearest lot line....... Number of lines__________________ ______ _______Length of each line------------------------------Width of trench---------------- Type ___--____Type of filter material_____ __ ______ _______Depth of filter material----------------- .....Total length.__-__-_____-_-________________ Seepag it: Distance to nearest well..�I@1�_$_ ._-_Distance from foundation_ J �iM Q.__.Dis�ance to nearest la rhe ------------- Number ofpits__ 1-_.--_.-_---------------Lining material:gRkC- ( :Size: Diam ter..:..'--------------Depth...1� ... •-----••- cesspool: Distance frgm nearest well-----------------Distance from foundation---------------_----Lining material-- .-:_-. ❑ Size: Diameter----------------- ----- Depth............ -------------- ----------_--Liquid Capacity--...........................gals. Privy: Distance from nearest well _-_ ------------------ }Di _:._. stance from nearest building------------------------ ❑ Distance to nearest lot line. . ------ - ---------•. --•-••••--•-•-----•-•••----._.._. ._..----____._... adelin and/gr repairing __._ Rem g / P g .mr ...^�•. --• __ "-'---a ---1,-- ___________________________________________________ ______.__1* ...................................I..........7�:,----------------------------------------Z.................. __...__ .....................>_.____________.___.______._.____._____.__ ___.______..._..__._________.___._._._.___.______. ________________________ __________________________________________________________________________________________________________________________________________________________e_____.__.__.___ 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)--•-- ........ ----••• --•••-- ----------------------------------------------------- -- --------------- -------- ------- -------------------------(Owner acrd/or Contractor) BY: -----------------------------•••------------------------------------------------ Title --- - -- ( ) ��1 (Plot plan, showing siz of lot, loc ion of system in relation to wells, buildings, etc., can be placed on flaverse side). Qo FOR DEPARTMENT USE ONLY v ' L APPLICATION ACCEPTED BY ..................................... DATE_ REVIEWEDBY................................................... -- -------: DATE-------- -- - --- --. ................... BUILDING PERMIT ISSUED. - ------- ------ --•_.__._. DATE. .......... j Alterations and/or recommendations:. = - - - --------------- --•--•-----------------•------------------------------•-------•-------------... .........................................----------------------------------------t•--•---••------...-------•-••--•--•••--•----•------•--••--•-•---•-----•-••-••-••----•----••-•--•--•---••• ....-. ---------------•-•---------------------------------------------•----•--------------------------------•- --•----- ••-•-- ----- •---------- --------•••-•••-- ._. ._..-•----.. FINAL INSPECTION BY:_ s. -• ---` •-- -- - - -- -- • Daae-.............. ---'!�=7___...i%_ -----...-•-----•--------••-----...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamora�Street 914 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12.54