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--APPLICATIOWFOR SANITATION PERMIT Permit (Complete in Duplicate) � Of Date Issued _-. ------------------ Applica-lion 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 withCounty Ordinance No. 549. JOB ADDRESS A pi O�ATION_-. --a f ------------------------------- Owner's Neme - --- --_-- ' - ------ Phone -------------------- -- -------- ----------------•-----------•-•------------------------------- Contractor's Name ------ Phone..__. ------ Installation Installation will serve: Residence VApartment House E] Commercial ElTrailer Court ❑ /Motel ❑ Other ElNumber of living units: _ ___ umber of bedrooms Z__ Number of baths --- Lot Water Supply: Public system 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 Hardpan ❑ ! Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j. I .-,... Septic Tank: Distance from 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 mateal-------------------------Depth of filter material_-__.__----_--.--.`.___Total length--------------- --------------------------- Seepage Pit: Distance to nearest well .__._--_.............Distance from foundation.............. to nearest lot line El Number of pits-------, -__. _t_._Lining material__.. _____.. ---------Size: Diam9te�-------- ----.Depth/-----" -- Cess o s Distance ffi•om a es# 11 �� ' } �` p ��stance from foundation-____n-1.0----------- material-- 4% . .F -- �E t (_. Size:Diameter_ -. �--_- D'eptly--------c^ ,----------- -- �j - ------Liquid Capacity--------_6- - ------gals. Privy: Distance from nearest well-------- -------------------- -__---_-----Distance from nearest building-----------------__-_.-_ _ ❑ Distance fo nearest lot line :. --------------------------------------------------------------- ------ Remodeling and/or repairing fdescribe)--------------------------- 11 4 Y ................s 1i ------------------------------------------------------------------- - - -------------------------------•.---._----_--_---.._--------------•----•----- -------------•---------- ---•--------'-----------•------------------------------------------------•------------.-----------------._.-----.---- I hereby certify that I have prepared this'application and that the work will-be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed) �� --— [ ' ------------------------------------------------------(Owner and/or Contractor] By:---•--------- --- -- ..� . -- --------------------------••- ------------------ ------------- - ----------- ------- - -------- - - ----(Title)._---------------- -------------------------- --------- .. (Plot plan, showing size of lot, location of system in relafion'to wells buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY----------------------- --•----- ------ ----------------------- DATE i.^r- BUILDING PERMIT ISSUED-------------------- _- DAT E---_-__-- :-- f,� Al eratipnt and/o• recommendatidns:..___- ------ ----- -----__ --,----___-- Al --------------------------------••--•------------••-••---------•--------------------------•----------- ------- d -- -------•--------•--...----•-- ------------------------------------- ------------------------ FINAL INSPECTION BY:- ------------------------------------------ Date--- .3 J 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---J-2M 145446 ATWOOD 12-54 1