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0 APPLICATION FOR SANITATION PERMIT Permit No. .._ ,1• - (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 Ordinan No. 549. JOB ADDRESS AN ATIO <� ;? -- -------- ------- _ ------------------------------------ ---------------------- wner's Name �L.'Ir3a-------------------------------------- Phone- Address �.3� o•'S 3 - - --------------------- -- -------------- ---------------i ------. ---------------------------------------------------------- j 11 Contractor's Name------------- /1/Z _ --------------- Phone_ ._..C2__=__ G`_G'� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ �yMotel ❑ Other ❑ Number of living units: _02- Number of bedrooms _-3.• Number of baths ___j__ Lot size ----f3_.3__. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 23--Hardpan ❑ Previous Application Made: Yes ❑ No [B (New Construction: Yes ❑ No [R- "._ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic nk: Distanc(j jf?m nearest well-----------------Distance from foundation--------------------Material__________-___ No. of compartments----- --------------------Size--------------------- - -----Liquid depth---------------------- Capacity ........-- Disposal Field: 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--------------------------------_......... ' �l !/ / Seepage Pit: Distance to nearest well _--___ ___. _Distan�,o-#fom foundation__f_C�..........Distance to nearest lot Number of pits. ._�___ _ ___:Lining material_ ._; ____---_Size: Diameter----.32_ � Deptn__ _ ._ Cesspool: Distance from nearest well__-_-__________ Distance from foundation. Cesspool. 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):------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- -----•-----•--------•--•--------•---------•------------------•---------•-------•-------------•-----•--•--------•-------•--•--------------•--------•---•-----------------------------•---- --------•--------------------•-•--------•-------•----•----------•----------------------------------••----------•-•-------------------------------•••-----•-•--•--------•----••-----•-•------ -----------------------• r •- ----------------•-----------------------•-------•-----•----------------------------•-----------•---------------•--••-----•--------------•-----•--•----- ------•-------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance.w#h San Joaquin County ordinances, S ffie laws, and rules %gulations ofd the San JQasquin Local Health District. (Signed)------. --- ` i ---- -- -- caner and/or Contractor] By:-------------------------- �,� . ...:�iT/ ------------------------------------------------(Title)-- ------ Ian, showing size ------------------------------------------ (PlotP 9 i,> location system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________________ ____ DATE___ ---- ------------------------------------------------------------- - - ------------------------------------------------- IEWED BY ------------------- I -- U 6- ----- - ----- - - ---------------- DATE-- �t ----------------- BUILDING PERMIT ISSUED_________ __ __ _ DATE._._._._._ -- Alterations and/or Commreendations----------- ------ --- --------- I ------- U - ----------------------------- - ------- ------------- --------------- - I Q-- K"— ____________________________ ______________________________________•____._____-_____-__- ________......______------------------_------------------------------------------------- P FINAL INSPECTION BY:------`.._ -------------- -------------- 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 745446 ATWOOD