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1� APPLICATION FOR SANITATION PERMIT Permit No. ................ (Complete in Duplicate) Date Issued ---- J-S4r- 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 Ord' No. 549. JOB ADDRESS ANDZC TION /7 ---------------------------- .......... ---------- Owner's Name------ 3 l�� • -- -- - -- -------------------- .-: -_ --_=--------.------ - --------------=---- Phone._/�_� t,Jt_._`�73 Address °z --- � / ------------------------------------------------------- ---------------------- Contractor's Name--------------- ----- r-----------------------------------r-------------------------- Phone_J�-.___6 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms __49 Number of'baths - ___ Lot size ---67_'X_104 ---_------_-- ------ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4/ f. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pa--'F~ardpan ❑ Previous Application Made: Yes ❑ No 2----New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti nk: Distance from nearest well-----------------Distance from foundation-------------------_Material-------------------------------------"---------- p ---- ---------Liquid depth--------------- ---------Capacity----------------------- No, of compartments _ Disp sgaltield: Distance from nearest well-----------------Distance from fou ndation___-----------------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__________-._.__.------------------.------ 1 Seepage it: Distance to nearest e11- Q' -_Distance fro founciotion___-I ___.Distance to nearest lot line__Q____ J# Number of pits- -----------Lining material__Se_-4hAFaC.S'ze: Diameter_ _._3j_-*_,1------Deptn.. AZ7---______-__._____._ Cesspool: Distance from nearest well-----------------Distance from foundat'on---.............---Lining material------------------------------------- S'ze: Diameter------------------ -- ----------------Depth--------------------------- ------------Liquid Capacity----------------------------gals. oma, Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building_____-____________-_.-_-_____ ❑ Distance to nearest lot line--------11-------------------------- - ----- - ------------------------------------------------=---------------- - Remodeling and/or repairing (describe):-------------------- ----------r ------------------------------•-------------•--------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------•-----------•-•-••--------------------- 4 ,.: rF -----------•---------------------- ------------------ ----- ----------------------------------------------------------------------------•----- -------------••------------------------------------•----------------- I hereby certify that I have-prepared this application-and that the work will be done in accordance with San Joaquin County.-. ordinances, 7aeaws, and rules and r ulations of the San Joaquin Local Health District.(Signed)------- --------- --------------- -------------=---------------- f------ IO er and/or Contras or( rm---- -----fti61- By: _ = :_(title) --,•-• -------•- (Piot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /7�_/ �C ------------------ -------------------------------- - �---------REVIEWED BY---- -•------- ----------•----------- -- -- � DATE---�� - �- -5-----------...--•-A A A P Y---------------- - ---- -----•---- •--• -------------------------- DATE------ ------------•------BUILDING PERMIT ISSUED--_-_--------------- - DATE.. __. Alterations and/or recommendations------------------=----------------------------------------------- ----------------- ---•-------•-•---------------------------•--------------------------------- ----•-------------•---------- ---------------------.------ ---------------------------•--------•-•-----------•-•-----------=------------•-----------------------------------------------------------n. _ FINAL INSPECTION BY:.. - ' " '��----•_ Date-- ' —�-' - --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California l I E5-9 145446 ATWOOD /