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� o C " -- APPLICATION FOR SANITATION PERMIT Permit No. ....�. -- c_- f in Duplicate)(Complete P te) 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 LOCATION............ . ._ -_. _-- ---`J-- 0110,,el-41� -------------------------------------------------------------------------------------------•-•-------------- Owner's Name...--- ------------ _.. ------ Phone.................................... Address.......... f .............. U Contractor's Name........ ...... .__ ._ ...... _.. --�--- --^------------------------------------------------------- Phone ------------------- Installation will serve: Residence Eg- Kpartment House E] Commercial ❑ Trailer Court ❑ Motel [I Other 1_ ❑ Number of living units: -__-_ Number of bedrooms --__ _. umber of baths ---/--_ Lot size ______ _________ �_!�----------------------- Water Supply: Public system X, 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 W. New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta :�- istance from nearest well_-;______________Distance from foundation__-_.__.--_--_-____.Material__-____----_-_---_---_--- ___--•__-__-_-_-_❑ f compartments--------------------------Size--------------------- ----------Liquid depth---------------- Capacity Disposal Field:, D' ante from nearest well-----------------Distance from foundation-_-.__.--_-.-_. ---.Distance to nearest lot line................. ❑ er of lines----------------------------------Length of each line------------------------------Width of trench Ty of filter material_________________________Depth of fil terial----.__--_._-____.---..Total length___-__-----_--_--:__---___-__. ------------ Seepage Pit: Distance to nearest well____-/' Ba-�C.$istae from f and 'on.___ __. .......Distance ' .� �_._.Distanc`to nearest lot line____�4%--`.._ Number of pits----/----------------Lining material_(,°,._�1 Diameter-------S-�-----Depth-. rC4------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____------__-_ ❑ Size: Diameter---------------------------- ---.D plh------------------- Liquid Capacity gals. Privy: Distance from nearest well_______ _____. -_-:_-------Distance from nearest building-__--_--.._-_____-___---__-._-.-_---_._. ❑ Distance to nearest lot line.____________________________._______..._._._ - Remodeling and/or repairing )describe):--------------------------------------------------------....................................... -----------------•---------------------------:------------------------------------------------------------_---------------------------------------------------------------------------------- ................- ---------- P ---------------------- ---------- -------------------------------------------------------------------------------------------- --------- ------ ,0 I hereby c ify that I have prepared this application and that the work will be done in accordance with San Joaquin County 7 ordinances, ate aws, and rules and regulations of the San Joaquin Local Health District. --r (Signed) --------------------- er and/or Contractor Plot Ian, s owm size of lot, location Asyvsf;em ----------------(Title)---••-- - _-_--.-.__ _______-______ ------------------- ( P 9in relationto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - DATE ------------------------------------- REVIEWED BY - DATE. ------ --- - BUILDING PERMIT ISSUED------ ----•----------------- ----.- DATE------ ----•--- - ---- -----------•-- Alterations and/or recommendations:... -------------- V -------------------------------------------------------------- lr --------------------------- ----..._ '-� -- � r - ----.................................. ---------------- -- V -----------------------------------------------------------.---------- ----------------------------------- ----- - -----•----------- � - FINAL INSPECTION BY. 5 ..-------- ...... Date...--------------------------- SAN ------_---------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-9-2M 145446 ATWOOD 12-54