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G y 7-- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. _._.. 4. I ' (Complete in Duplicate) 7 J Date Issued ---- , Applica+ion is hereby made to the San Joaquin.Local Health District for a permit to construct and instal the work herein described. This application is made in compliance with County Ordinance No. 549. all A4,1" tt JOB ADDRESS AND LOCATION........�i l ''� u ....... T -S------- ---------- --------------------------------------- Owner's -----------Owner s Name----------- 1=!?rScrl7------d-------- _ ` _<� ...----------------------- rL .Jone.................................... Address------------------------------------ •----------------------------- --•�•---------------------------------------- ---------•----------------------------------•---------------------------•----•-- Contrector's Name-•-•---------------(-1tP----•- -S--d---...-------•-•---•----•-•-•- ----------------------- ------------------ Phone--------•-- ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____________________•-__-______-_-_-._______---_-------___-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Mader Yes ❑ No ❑ New Construction: Yes ❑ 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------------------Distance from foundation-------------------.Material_______-_-_-._._-_-_---_--_____-_.--_._-________- No. of compartments--------------------------Size--------------------------------Liquid depth .--_.._ _.---------Capacity .----______--- r Dis os "FielcT: Distance from nearest well _Distance from foundation.......... ........Distance to nearest lot line--_._-..._......_ Number of lines_________________________________Length of each line-------------/-------------Width of trench.......................... Type of filter material---_ -__--- -.. .._Depth of filter material._........ ..........Total length....._...._'jL- .................. Seepage Pit: Distance to nearest well__--------------------Distance from foundation....................Distance to nearest lot line__-____-___-____. ❑ Number of pits----------------------Lining material-----------------------Size: 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----- -----------------------•----------•---------•------•----------------••-------•-------•----•---------•--- ---------------•---•---- Remodeling and/or repairing (describe) = ! — '`' ................................ --------------------------------------•--•----•---- . • . —• ----------- �'------ ...............................•-------------•-••---------•--•-----•--- ----- - --------- �. ..1~.�.- --- ..... --------------------------------------------------------------------- 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 and/or Contractor) f- .. ..G 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 APPLICATIONACCEPTED BY----------------------------------------'------------- ........................................... DATE............................................................ REVIEWEDBY------------------------------------------------------ --------------- •-------------- ------ i DATE------------- ............................................ BUILDING PERMIT ISSUED............ G DATE-----------------------------------------------------•------- Alterations and/or recommendations:...................... ------------------------------------- --- ------- ----•--------------------- --------------------------------------------------------------------------- -- ----------- ----------------------------------•-..._... ------------------------------------------- ---------•-- -----•------ - ------------.--------------------•---............... -----------------•--------------------•---------------------------------------•--- ----------------------------------------------------------------------- ----••---•-- -------------•--------------------------- FINAL INSPECTION BY:.- '�.... Date. ' �l -j--------------------------------•------•----------- 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 E5-9-2M 145446 ATWOOD 12-54