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APPLICATION FOR SANITATION PERMIT Permit No. d z_0........ (Complete in Duplicate) � Date Issued Applica4-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,,lwith Count rdinance 549. JOBADDRESS AN LOCATION_.__.,C.- --- G------ . ......-------......-------------•-------------------------------------------•. Owner's Name... ........... ------------- - - ••---------------......................-�------------------- -------------------------------------------- Phone.................................... Address ...................... ,�j Contractor's Name.--- ..f.. _ � __ Phon4J--@__. -._ Installation will serve: Residence ift—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/--- Number of bedrooms _ Number of baths J... Lot size -.4-S-10...... -.•...0____r-Z____C------ •-__-•_--__--_ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6--FfV*an ❑ Previous Application Made: Yes ❑ No 9_141e"onstruction: Yes 6_40-B TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew i a*1 ble within 200 feet.) Septi Tank: Distance from nearest we is an from foundation_._ /_ _ ... y� ,p .._._._./ No. of compartments Size---. �_ Q_.Liquid de th_-_ P ------------ - - - q p �1%----------Capac�tY---�S---Q-- ;; Disposal Field: Distance from nearest well.-- -�11e Distance from foundation..../Q.f...Distance to nearest lot line-___f�--• 4 Number of lines------------t__ ----- ---- _ ength of each line...... __. .___-_.Width of trerich-__0�---_.__.._-__-_- Type of filter material.._ _ _ _... Depth of filter material_..__. ._Y_" Total length_-_--•:. ____________________•----- Seeps a Pit: Distance to nearest well_. _ __ Distance m fou ation___� ""'D' to � to nearest lot line__Z-a____ Number of pits-_! Lining material_ Size: Diameter_. f/�--r .Depth:_�.0..._..<.: ... 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):-------------------- ------------------------------------------•------------•------------_----- ' --------------------•-----------------------------•--•------------------------------------------------•-------------------------------------•---•----•------------------------------•-------.----•----------•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, law , and r s and regulation4oft San Joaquin Local H ith District. (Signed) - ---- - `CContractor) BY: ► .....(Title)-•- ---------ti`---------------------------------------- (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------------------------- ------- ........---------------------------------------- --------------------------------- DATE.----:-- BUILDING PERMIT ISSUED------------• ------ DATE- \...----•••-------------•.•.------••-.--..-.--- Alterationsand/or recommendations:------------------ .......................--............................................................................................................... -----------------------------•------------•---------•----------------------------------•-•-•------------ ------•-•-•------•--••------•--•-•••-•----•••----•-••-••-----------•-•---•--•--•••-•--•--•----•----------••••_-•-••- ------------------------------------------------•-•------------------•----------------------------•---------------•--••--------------•--------•-------------•-----•---•-----•._..••-•-•-•---•......•-•-•----•--•-•--•..... -•------------------•-•-•----------------------------------•------------ .............. ------------------------------------------ -------------------------------------------------............................ ----------------------------------•------------ --------------. ..---... -------------- .-------------__-----------------------.-----..-..---------.•-.--------..--_---------•-----------------------.----.-------- S Date... - .......... ............. �J----------------------------- FINAL INSPECTION BY____ ____________________ 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-9-2M 145446 ATWOOD 12-54 //