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APPLICATION FOR SANITATION PERMIT Permit No. _A_ 3..... 011 (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 AND C�AaT.ION---f ---.`.�� ..------..x e�-------- -------------------- Owner's Name-------- __' -- Phone.................................... Address_.... = ' ----------------------------------------•- Contractor's Name " -- --- ---'-- -- , . �-� 'Phone---------------------------•_ Installation will serve: Residence R]''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -1 f Number of living units: .f.._ Number of bedrooms .R_ Number of baths _, .. Lot size ___ ..�___ . 0 " Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table%r 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 [ lo❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w I_ A-^.'Distanc`e�from foundation tP__________.Material____ re... ......... . ... ........... No. of compartments______________ _____Size__A0___�.�___0.....Liquid depth--_ Capacity ,L • F Disposal Field: Distance from nearest well-/�1�7L�-°Distance from foundation Distance to nearest lot line g��---------- �''� Number of lines______ ______ ----_/-Length of each line______: _. __ lj rr �� aa�t�.--- A-----.Width of trench------- -�-------------------- Type of filter material_/ ._Af7-*-Depth of filter material----/X_.._ ----Total length-------u� .A ...f.................... Seepage Pit: Distance to nearest well._._`*X---�-__Distance from-foupation...12__......Distance to nearest lot line---0'7...... lei1 .11 Number of pits.--- ----.--------Lining mate ria leAdA Size: Diameter.-SIT-----------.Depth----.-2-M -------------- Cesspool: Distance from nearest well_________________Distance from foundation----------------.---Lining material__.----_._--__.-_._-.--.----_________. ❑ Size: Diameter.---- ------Depth-------------------_------ ------Liquid Capacity--_-----------------------gals. r �` Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.--------------------------------......... "� ❑ Distance to nearest lot line--.---------------------------------------•----------•-•-----••----_--------------•-------•-----•---------•------•-----•----------------- Remodeling and/or repairing (describe)---------� � �........ --- -�6�'��'-----------........................................................ -----------•---------------------------------------•-------------------------------------•------------------------------------------------------------------------- .......................................................... --- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)-------- st - ------------------------------ r Contractor) B ................................ `_ - -- ---- - .. Title._.. Y� -- - - --- -- ( ) ------- (Plot plan, showing size of I, , location of system in relation to wells, buildings, etc., can be placed on reverses eitQ ). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ........................... ---------- DATE ---------------------------------------------------- REVIEWED BY------_------ ------------ -- --- •--....._..... DATE---� -------- BUILDINGPERMIT ISSUED----------- -------------------------------•--•--------------------------------------------------- DATE --- -�---------------------- ----- Alterations and/ r recommendatjons: --� ---------------- "" �. ....��----- --- - ............. ---------------------------------------------- -- ------------ ..--- --------------......------•----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------- FINAL INSPECTION BY:...---C-&.34----------------------------------------- Date. =57----- ---------------- 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 -