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1y _ APPLICATION FOR SANITATION PERMIT Permit No. ___. ..�. Com lets in Du licate q"Z1 V ( P P ) Date Issued Applica+'ron 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 AND LOCATION_________ ____ ____ G�"�" -- ----- ------------------------------------------------------- Owner's Name...................... . -e- --- -- - - ------- ... -- ----- . --- ---�' ----?--------------- --• Phone.................................... 141 Address '-• . .-- ...... �----- �•- --------------- Contractor's tame- �� -- ! a ? - ---- --- - ---------- PhoneQ` _. /�G Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 1Other Number of living units: Num.bAwof bedrooms �,_ Number of baths I.... Lot size [---- --------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_- ft. Character of soil to a depth of 3 feet: Sand ❑ el ❑ Sandy Loam ❑ Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes o ❑ 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----------------------- Dispos6 Fiel Distance from nearest well_...............Distance from foundation__-_-----___--__-:.Distance to nearest lot line................. � Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material________________________ Depth of filter material--------__._._.--------Total length.......................................... Seepage Pit: Distance to nearest well_[----------_:-Distance from fo dation_,�D-•-_-._..Distance to nearest Jot line__�.�._.._ 41 /� Number of pits..6'1q--'-.._.__..Lining materia,-)Y.` ._Size: Diameter-_---J' j --_-.-_-.Depth---.,,?4--_�------_-_---- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- -----Lining material-------------_.-____._.-.__--___-----. � ❑ Size: Diameter-------------------------------------Depth----•--•--------------------- -------_-- ..........Liquid Capacity--..........................gals. Priv Distance from nearest well__--_.._.-__-___________________--_.--------Distance from nearest building g ❑ Distance to nearest lot line--.-- •---------------------------•-•-•------- Remodeling and/or repairing (describe)--------------- = - - _-_- - ---`----- --- ----- ----- •-- N- ------a----- ..................................................... -----------•r-• ----•- - - ------- ------------------- --------- •-' ------------•. . ---- --------------------------------------- ---------- ------------------------------- ----- --------------------------------•------•------------ - - - - - - - -----------------•---- --•-----------------------------•-------•--------•--------------------•-------------- I hereby certify that I have prepared this application and t at the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations f the San Joa in Local Health District. (Signed)---- ---• - 'f.r/ -- ----- - = r ---(O er and/ Contractor) - ------ ---------------------------------------- --------------------Title •.. 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 APPLICATION ACCEPTED BY. -------r ------ - DATE -'' REVIEWEDBY-------------------------------- ---------- ------ --------------------------------------------------------- DATE-- ----- -. ---•------------------•-.........-•-------- BUILDING PERMIT ISSUED--- ---- ----- ----- --------- --------- ------- ---------------------------- ------ --- DATE__.._.:._ ___. �._.`_____ Alterations and/or recommendations-------------------- -=- - -- - - .... .. __...__.._.........._ v ---------- ---------- ___ _ ___ _ _________ _________ _____ ____ FINAL INSPECTION BY:----------------------------- Z -------------- - ------ Date------ .................................. 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