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APPLICATION FOR SANITATION PERMIT Permit No. ___�_.�.......-.g._. (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 A LOCA 1 _/...0_ 4... _ _. .. i Owner's Name. . - .........._ Phone Address.......... __ --------------•8 ................................. ---•----------------••-•-----------••-------------------------------------------•---------•------------- Contractor's Name--------9 --- ...... -Phonel.: � �_. Installation will serve: Residence J§. Almirtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms .0,.-Number of baths __'-_- Lot size -----fi..0-__--X. ________________________ Water Supply: Public system 4 .Ge�_tq^-system ❑ Private ❑ Depth to Water Table Zvft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4-w"Alw ❑ Previous Application Made: Yes ❑ No ,-Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments------------------------.Size................................Liquid depth--------------------------Capacity--------------------•-• posal Field. Distance from nearest well -Distance from foundation--------------------Distance to nearest lot line................. S Number of lines.............._____________________Leng& of each line-------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... Seepage Pit: Distance to nearest well - ------Distance from fo ndation../.,2.._t .....Distance to nearest lot line } .�._ jNumber of pits--•---/-------------Lining material ---Size: Diameter.. '...........Depth--. Tr 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-------._-.___.__________--_-,--_.--_--.-. W . ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------•----------•----•••-------•----••------------•-------- Remodeling and/or repairing (describe):......................................................................................................................................................... " ---------------------------•-•-------------------------------------•------------------------------------------------------------------------------------------- ------------------•--•-----------•--------------------------- •----•--------------------•-•-••........-----••••-•-•••-•------•--•----•----••••-•••-•----••--••--•--•-•--------•---••-•----••-•------••-•--••--•---•--•--•--•-----------•----•------•--••-•-••••-•---•-•------•-••-------- . =--------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------------=-- ------------------------ 1 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 rul s and regu tions of the San Joaquin Local Health District. (Signed)--- ..--• - •-•--- ----• --- ....... - ------ -- ---------------------------------------------------------«;;---------(- Contractor) By:. •�i•�*•r� -------- ------- .............................................(Title)----------------------------------------------------------------- (Plot plan, owing 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__/6."77 BUILDING PERMIT ISSUED................ ------ .- S Alterations and/or recommendations------------------- ------- --------- ------------------------------------------...........................------------•-----•------------••------------- { �) ft= % �r --------------� --- FINAL INSPECTION BY:.. ---------------------- ---- ---------- Date....A----------------- ------------------------------------------- SAN --------------------•---- 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