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I APPLICATION,.FOR SANITATION PERMIT Permit No. .�.�?3�..... (Complete in Duplicate) 3 Date Issued Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with Count Ordinance o. 549 JOBADDRESS A CATI �N1-crS / -- --- - ---- -- ------ -------------- ------------------------------------------------------------------.......................... Owner's Name...... •----••-• . .✓-- ---- ----' -------•-• --- --------------------- ---------------- -- Phone.................................... Address..........02••-- ........ .... .----- ---• -•--•• •---------•-- .. Contractor's Name......._ - ---- ------------------------------------------------------------- ----------------------------------------------------- Phone................................... Installation will serve: Residence .r�' Apartment House F] Commercial [-] Trailer Court E] Motel ❑ Other ❑ Number of living units: .-/-... Number of bedrooms ., Number of baths __,t+.._. Lot size _-'_Q-...�...L..LD------------------------ Water Supply: Public system ht 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 5( 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.) Sepfiic 1\11r1kS4 Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------------------.............. ❑ 10. of compartments----------- -------�Size--------------------------------Liquid clep h-------------------------Capacity------------ Disposal Field: Distance from nearest well 70-----Distance from foundati n..-. ..L�......_.Distance to nearest Iqt line... Number of lines--------I------------------------- th f each line.....�SO-..____._______.Width of trench. _ �...2-:\ z-__-__:--__--_-_I Type of filter material 'moi ",!C,=6er material-----) ----------Total length------- Of ----------------------L Seepage Pit: Distance to nearest well--- ------- --------Distance from foundation....................Distance to nearest lot line--............... ❑ Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth-----------------___•---_____--__ Cesspool: Distance from nearest well-----------------Distance from foundation-----------_--_.--..Lining material--..---_--_-__-__-____-___--•--_--•--. ❑ Size: Diameter--------•--•--------------------------Depth----------------•--•-------------------------------Liquid Capacity..--------------------------gals. Privy: Distance from nearest well----------------.--------------------------------Distance from nearest building_-_--_-•--_•..___________--_---------_-_. ❑ Distance to nearest lot line----------------------------------------------------------------------------•-------------------------•--------------01-----•------•------- L�fi� r �// /L� Remo ling a r repairin de�ribe):..- ------ --•--•---- . -- • -•-- , P"'..'.-------• r ... ....••.... --- -----------•---................................................ -•---- -•-............. • •••• ••••-•--•----•---•••-•••----•-•--•-----•-----------•••••-•---••-••--•-••-••--•-----------••-•....-_---- -------•-------------------•---------------------------------•-------------------------•-------•------------------------•---•----•-----------------------•---------•-------•------------•---------••------------------------- 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 reguations of the San Joaquin Local Health District. (Signed) � --------------- ------------------------ (Owner and/or Contractor) By:.........................................................................................------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ------------------ ----------- ------------ ••••••--••••......-•-•----••••--•------- DATE --------------------------------------- REVIEWED BY-------------------------------------------------- ............. DATE-------- BUILDING PERMIT ISSUED------------_------------- --------- ------------------------ ------ DATE---------------- - ---- --------------- Alterations and/or recommendations-------- -------------- -------• ••----------••••-••••••••••....•--••••••-•-••••-•••-•••----••......••-•--............. --•- •••• p----•----------- •--•---•---------•-••••---•••--•--••-•••-•------••-•••-----•...--------•----------------•-------------..__....-------•--••••-----••••••-••......•-••••-------•--••--•-••••--••--•-••--•••-••---•-•-...................-••••-- -----------.................................................................----.........-.................................................................................................................................... ------------- -------------•-----..--------------------------------------------- ................ --------------------------------------------------------................................ ............ --•-------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_..�.5_ `TT SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street k814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOD 12-54