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APPLICATION FOR SANITATION PERMIT Permit No. ___ -l -L-•- (Complete in Duplicate) Date Issued ...?/N/S� 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. \% G1 +----------------------------- --------- --------------------------------------------- JOB ADDRESS AND LOCATION-------- --i 0------- ---- ----------- Phone------------------------------------ Owner's ------------------------•----------Owner s Name__.L-1---------- -------------------- Address--------zs--- 2--- �--U- `43_ ----------------------------------------------------------------------------------------------------- • ' L / 4 ----.-----------•--------- Phone �5f-� Contractors Name------ ---��-�---- `ts-------- - Installation will serve: Residence �g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑__�---- Lot size ____- �— ___ Number of baths �__()----x----��--�------------------------- Number of living units: ___,�__ Number of bedrooms _ - Water Supply: Public system pQ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [A Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta - t, ce from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- ❑ No.;f compartments---- ------------------Size-•----------•-------------------Liquid depth----------------- --------Capacity- Disposal Field: ante from nearest well_________________Distance from foundation--------------------Distance to nearest lot line________________. ❑ f lines ---------Length of each line------------------------------Width of trench----------------------------------- Type of titter material------------------------- of filter material____._____--.____._-_Total length__________________________________,______ Seepage Pit: Distance to nearest well-------- from,�jounclati n______ I� Distarlye to nearest lot line_T_ ________ q Number.of pits-----.--I-----------Lining material__!°_('i--lC- Zi Diameter----.5- ----------Depth----- ---------------•-- \n"� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________..______________-_-_-. ❑ Size: Diameter--------------------------------------Depth...... --------------- ----------------- ------- -- ------Depth.----••--------------•------ ----- -- __.____-__Liquid Capacity gals. \„ Privy: Distance from nearest well---------.----------------.----------------------Distance from nearest building_________________________________________ Distance to nearest lot line-------------------------------------------- Remodelingand/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, State I and rules and regulations of the San Joaquin Local Health District. -----------_---------------(Owner and/or Contractor)-------------------------------- \ (Signed)_ rf�t- = -- ,t -----------------------------------------.____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 ° --------------------------------- DATE_ k ' APPLICATION ACCEPTED BYE-� --- --- -------- --- ---- - - --------------- - - `�.*�----------------------------.. REVIEWED BY------------------------------ =m ---------------------------------------------------- ------------------- DATE----"' -------------------------------------- BUILDING PERMIT ISSUED._____..---`-"------------------------------------------- ------------------------------------------- DATE. &t\--------------------------------------------- Alterations \--------------------------------------------- Alterations and/or recommendations:---- ------------- ---------------------------------------------------------------------------------------- ---------- ---------------------------------------- --- --------------------------------- � FINAL INSPECTION BY----------------------11_ht�ztl-/11----------- Date----------- ------� ---------- -------s -- ---------------•---------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54