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p' APPLICATION FOR SANITATION PERMIT Permit No. ..._.�f-1a.0.illi-- (Complete in Duplicate) Date Issued E 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 AND OC ION.. '----.----� Q •" i �� gni Qs °+� G_A. Y_ � --illi-- Phone._.. --ff-�----------•---- �V4 $• __ I D ------- --------------- Owner s ,e-------- -� -�'.�.•---...�.�►.�-ri-�-�- - -�- -----•�---•---- --illi-- - - -:.-_ I _ '--- ----------------------------------------•------------- Addrass.__ - ---- ------ ------ Contractor's Nam - -.�,��'.__._��_-�-+-A..---••-illi-- - -- -------------------------illi-- --------------=--illi•illi-----•-- --.. _ Phone__ --- -- --------- Installation will serve- Residence ❑ Apartment House E] Commercial Trailer Court [3Motei� Other El Number of living units: -------- Number of bedrooms -------- Number of Laths __!_ Lot size ----------- �-----��' s--- ----- Water Supply: Public system ❑ Community system ❑ Private Number to Water Table ft. Adobe Hardpan Ad ❑ p ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa Clay Loam ❑ Clay ❑ I Previous Application Made: Yes ❑ No Z/New Construction: Yes EfrNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) TP �=:T r �-»- - Material - -�- -- - - -------------------------------- Septic Tank: Distance from nearest well------------------ _,_ .._..,__ _Distance from foundation - Capacity 0��S erq No. of compartments---------- -------- ----Size--------------------------------Liquid depth - -- p ----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation_ ________Distance tnearest lottline___-_-_-..-_----_ Number of lines----------------- -----------------Length of each line_. Width of tranch. Type of filter material-------------------------Depth of filter material--------------_------Total length------------------------------ _ �f�,_.Distance to nearest lot lit_J�' e. Seepa it: Distance to nearest well.____...__"._.______"Distance from foundation__'_- r ----Size: Diameter. ... Depth Number of pits...._-----------Lining material._a1- " Cesspool: Distance from nearest well_________________Distance from foundation.__.-___--._....--- Lining material------------------------------------- r ❑ Size: Diameter Depth -- ------ - ---- - Liquid Capacity_. gals. ce from nearest well ............. ------Distance from nearest building--------------------------------------- Privy: Distance -- ❑ Distance to nearest'lot line-- ----------------illi-- r ----------•illi-- illi-illi--------------•--illi-- - - -illi--�'----�---�-------'-"---- illi-- • - � ''' ... Re ling and/or re airin Idescri .-- ------ ------•-- --=illi ---• ^` ---------------------•----------------•------ ------------------•--------- -- • ------------------------------ ------------------------------------------------• ------------------ ------ •---•---------------------- illi n a ia�iu I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County regulations of the San Joaquin Local Health District. ordinances, State laws, and rules and �d) (Owner and/or Contractor)- illi-- -S;gn � --illi-- ---illi--------�--- - =-- illi-• --------------illi-- ---illi-- ------illi-- - ----- -- ------- ---- - [ (Title �� v:- _--------- --------------------------------------------------- - $ :--------------- - - s - - �.}_,. --_ y. .. . r- planshowing size of ;location of'system in relation to wells, buildings, etc., can be placed on reverse si ). !�10, F E AR MENT U E ONLY 011 - - - ------ - ------------------- DATE .__5 APPLICATION ACCEPTED BY - DATE----------------•----- -----------•-------------•---------- REVIEWEDBY------_-------------------------------------- ----------------------- ------- DATE -- illi--- ------------•- .,,BUILDING PERMIT ISSUE -------•---------- ---------•----------------------------- ----------illi-- ---- I Alterations and/or recommendations:-------------------------------------------------------------------------------illi--•-----------•----------------------•----------...------------------illi-- --------------------------------------- ------------------------------- F ...-------illi--------------------------- ------------ --- ----------- -------------------------- ------------ s F1NAL INSPECTION BY:------ ...... illi. -_= = ------------ Date -----— ---- ----- Date ------------------------------------ -----SAN JOAQUIN LOCAL HEALTH DISTRICT x°s ... 814 North "C" Street 132 Sycamore Street 300 West Oak Street 130 South American Street :' Trac California Stockton, California Lodi, California Manteoa, California Y. ES-9 145446 ATWOOD _