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SU j APPLICATION FOR SANITATION PERMIT Permit No. .. tv,,A A/0V (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 ANQ LOCATION---- -- - ~-- ----- _ f ' Owner's Name-- Phone. = Address �� -------- :;&?' --_-- ------------------------ Contractor's Name________ ^ -------------------------------------------------------- Phone__-& Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms Number of baths __/... Lot size ____ch .__�7_3_7"__________________ Water Supply: Public system 13,_ Community system ❑ Private ❑ Depth to Water Table _c.�S_®ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No a New Construction: Yes ❑ No a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k. from nearest well_;________-___Distance from foundation-------------------- Size-------------------------- -----Liquid depth--------------------------Capacity Disposal Field: ce from nearest well------___.------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ of lines----------------- -----------------Length of each line-----------------------------Width of trench Type of filter material----------------------___Depth of filter material------------------.--__Total length__________________________________________ Seepage Pit: Distance to nearest well----N1'-n ---Distance from f un a •on �_- ___.Distance fo nearest lot line____, , # Number of pits------ ___________Lining material_ _I 96: Diameter___- ` Depth ------' ` Cesspool: Distance from nearest well--------------_...Distance from foundation-------------------.Lining material------ __.._______.______________._--- `` ❑ Size: Diameter - -------Depth---------------- ----•-----------------------------Liquid CapacitY--------------------------•-gals. N` - Privy: Distance from nearest well__________ 9_______________________________________Distance from nearest building S - ❑ Distance to nearest lot line------------•--------------------------------- -----------•---•----..._._ -- ----------------------------- oQ Remodeling and/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, ;Sfaf ws, and rules and regulations of the San Joaquin Local Health District. (Signed) ' 1,.-------`�-------.;:----.. J (Owner and/or Contractor) By:---- Z/ (rifle) -- --------------------------------- --- (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- - ------------_- ---------------------------------- ------ DATE REVIEWEDBY--------------------------------�---��--- --------------------------------------------------------------------------- DATE__.,` ---------------•--------------------------------- BUILDING PERMIT ISSUED. �' -----_ DATE---- Alterations and/or recommendations:--------------------------- ---------------------------- _______. ----------------------------------------------------------------------------------------------------------------- ---------•--- ------------- ------------------------• ------------- ------------ ------------------------ -- - ----------------------------- ------------------------------------------ FINAL INSPECTION BY:----- l C13. r�i Date ' /- - 6 ------------------------------------------------------ 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 E5-9-2M 145446 ATWOOD 12-54