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-',;!.APPLICATION FOR SANITATION PERMIT Permit No. .......... Date (Complete in Duplicate) bate Issued -- � - Applica+ion is hereby made oah' San Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance wit County Ordinance No. 549. ADDRESS AND LO ATION_ Owner's Name__________ ____ ______ f --- .. ---------- - ---- ne---------------- ------- Address-------------------- -- ---- � �fI � s" - ••---- --- - -- -- --- ---- --•--- -- ------ -- ------ Contractor's Name- j --- •-.--... a-a-- - - - .� Phone •--------------- lnstalla+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-.7_-- Number of bedrooms - �- Number of b the - __.--_ Lot size --._- �-----�---Vis_-----�---.1_-------•- Water Supply: Public system ❑ Community system ❑ Privat; epth to Water Tabley�_ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ ala Loam Clay i Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑i 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 Tan%k- Distance from nearest well----------- Distance from foundation----------- 0S -.___--.Material No, of compartments_. ---- ------•-----•-----------•-----.- Liquid depth---------- ------- ----Capacity--------- - Disposal fField: Distance from nearest well_ i Distance from foundation.--- ------ -Distance to nearest lot [ Number of lines-_--� - '-_- ../,1_Length of. each line---- — � f g --------.7-----Width of trench--- - ------- -- Type of filter material-S•. __ ._ - �-_-Depth of filter material....1�__,�-'-.___--_-Total length-----��`- _ - ----- ----------------- Seepage Pit: Distance to nearest well_� __r---__ _-Distance from fo dation-_��_�_•_- � Distance to nearest lot line__/_�S_---_-- Number of pits-. ------------- Lining materialf Size: Diameter- � s i a Depth ------- esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------- n Size: _----Depth----i- ----------------------- ____.---th----------------------- ----------- ---------------Liquid Capacity------- ___.--- ---_-- : -----------------gals. ----------Distance from nearest buildin Privy- Distance from nerest well---_.-__71 _____________ ---------- Distance to nearest lot line---__---..._................. . ------ ---------- --- -------------- ---- -------X-------------_--�---------_-- Remodeling and/or repairing (describe)------------------ _e-- -------- -- ----•------- --------------- -- - --- ----------- --- _ tom' I hereby certify that I have prepared t is applic ion and that the work will be done in accordance with San Joaquin County ordinances, Sta+e I ws- nd rules and gulatio s he San Joaquin Local Heal+h istrict. (Signed).. ---- ------- ----- -------- ----- ---- - ------- -- - (Own nd/or n+ractor) By: Ti+le - - ----------- -- ------------------------------------------------------- -- - (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.........--4........___________ DATE _ REVIEWED BY .-..---- ---------- ---------- ------------- ---------------------------------. DAT - -.------- BUILDING PERMIT ISSUED-------------I_ ':._-_______ = ----------- DATE----- -- --------------- Alterations ;� �si and/or recommendations-------------. >-;- 1 ---------------------------------------------------------------- -------•----------------------- �x:, --------------------- - ---------- --------- -- - ------- ----- ------------ ----•------------------••------------------- --------------------- FINAL INSPECTION BY___________ ----- ---------•--------- -----•------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Califorriie7 '' * Lodi, California Manteca, California Tracy, California E5-9-2M 745446 ATWOOD• 12-54