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'_ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) j (� 42J D Date Issued _______�-_.-_ 1 Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described.` € This application is made in compliance with County Ordinance"No..549, f - JOB ADDRESS AND LOCPIO �h ,;,, _'' - ----------- •----•---------- --------------- Owner's Name. ! _ �-----7�, ��: '/ ---- -------- Phone ' ---- -------- 11 Address-------------- `� -------------------- Conf ractor's Name----------- --- A�' J Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M el ¢ F ❑ Other ❑ Number of living units: __�_-- Number of bedrooms __ Number of baths __ �'- �-- Lot size --- -•- -------'--------•------ ------------------ ----- '�'� Water Supply: Public system E] Community system E] Private & Depth to Water Tablefta. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6--nardpan ❑ D Previous Application Made: Yes ❑ No P§'' New'Construction: Yes ❑ No Rg--a'- TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -- - eptic�iTa Distance from nearest wel{__:�- ____.___Distance from foundation--------------------Material______- =F_ ____________________. No. of compartments--------------- Size__:. Li uid de thCapacityr '_....Distance to nearest lot line____________ I. Fi Id: Distance from nearest well_________________Distance from foundation___ f p ______- T I (,� Number of lines---------/.................Fq---Length of each line----_- -------------Width of trench___._..RI------------------------- Type of fitter material__/�;__�-:��L/_Depth of filter material_.....:fdf� `_`._----.-Total length----.__-� ._- -- ------------------- Seepage Pit: Distance to nearest well---___4 __Distance fromfoundation_Ife'_.._____.Distance to nearest lot.line u [ Number of pits..------- -A.____---Lining materialr� _ "Size: Diameter_. --____..----Depth------4, q---- Cesspool• Distance from nearest well------------------Distance from foundation._._.___._._-_-__- Lining material------------------------- - ❑ Size: Diameter .` Death--------------------•--------- - ---.---------------Liquid Capacity----------------------------gals, f Dista.nco.:rro ..nearest well ------ --- :_ ___..._._Distance_from nearest buildin m -_..� ---------------------1----------- Distance to-Kearest°lot line ❑ ---------------------- ----------------------- 7 Remodeling and/or repairing (describe): ( ' -------lt ✓��',�'�-- r ----------- y� -- == -.• ---- - -----•----------------------------- ---------------------- -------------------- •------- -----•-----------•--------•----------••--------------- ------------------ ----------------------------------------- I hereby certify that I have prepared this application and that the work will bedone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ - ---�-�'-�--=�A ., - -- B r Contractor) ------------------------------- Y•--- (Title)_' C or) (Plot plan, showing size of lot, locatior�f system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... ,,_.- - - .� DATE.- ----- --------------------------- REVIEWED BY --------- ----- --- -------- ----- -------------- DATE------- - BUILDING PERMIT ISSUED-:'---. - ---------------------- - -- DATE.---------------- ------ - - -----------------------•---------- M - ---- - -- - ------------ _ Alterations and/or recommends ;ons:_-_-__._._ ---------------------------- --------------- ___ _________________ __-----------•--- -- •-----•---- ------------------•-----' ------ - -- --- - ------------------------------------ •----------- --•-------- - --- � ------------------------ -------•----------------------- --•------- ---------------------- ,;.- ----------- ---- . -- ---------------------- FINAL INSPECTION BY:.-----.. - --------- Date-------------------- �------•- --------�•--------- - I 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 145446 ATWOOD � ;