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ry1� •y�� APPLICATION FOR SANITATION PERMIT Permit No. (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. 5,49. JOB ADDRESS AND LOCATION••- %P__ ------44 -- ------ -----` Owner's Name......../��L.zr --- • - - - - •- - ------------------------------------ Phone.................................... Address------ ------ + - ----------------------- ------•----•----•--------------------------•---------------------------•----------- Contractor's Name........... -• '�� L ,a - . Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms /--- Number of baths __l___ Lot size __a -----X_/_��________________________ Water Supply: Public system 9-Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ lay Loam ❑ Clay ❑ Adobe ardpan ❑ 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.,l nn Septic Ta k: Distance from nearest wel istance f om foundation._-�..............Material__l�'. ___ _.- . . : _ _:_'_______. No. of compartments__ 11 ._ _-_____._-__Size_."t,Y_�Q•-__Liquid depth_._' P Capacity__._ .. g� - E Disposal Field: Distance from nearest well Distance from foundatio _f�V----------Distance to nearest lot line... Number of lines........ ____________ Length of each line___®E___�� Width of 10q Number Type of filter material _ _ ______ p g __De th of filter material____ _ ______Total len th__..___c `f_________________________ Seepage Pit: Distance to nearest well-.- ._Distance from fou dation___fa..........Distance to nearest lot line i7_______ Number of pits------I------------Lining mate -_Size: 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----------------------I=-----------------------------------•----•--- ----------------------- ---------------------•-------------•-------- Remodeling and/or repairing (describe)------------C F------ --- +.2- --- -------------------------•------ --------------•------------•-•-------•--------•----•-----------•••--------•-------•------- •------••---•---------•-----------••--•--••---•-•---------- -----------------------•-•------------- •----• j ---------•---•------------------•---------------••-••---------•----------•---------------------------------- ---------------•--------------•--------------••---•-------•----•-----•------------------•--•-----•---------•- -------•----•-------------------------------------•------------------•--------•----------•--------••----•----•--------•-----------••-•-•---------•---•-•-------------•----•-•------•--------- •----•_-_---••---------------- 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, ano rules and regulat' ns of the San Joaquin Loc Health District. (Signed) __ wlit 10 Oar Contractor BY: - -- - -- - ------ -(Title) `% , ��' - (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on revers ideew FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- - ------------_-- -- -------------------------- ------------------------------------------- DATE-r-_-•-------------------------___-------------------- REVIEWED BY DATE. ------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------•---.................................... DATE.-------. . Alterations an r r@c mmendatio s:- r ---- ----------•----------------•-------------------•---•--------- - - .._. ig _...-----•---•••---• ----•- V � - ...--•-------•-•-------•-•---••-------••-•--••--••----•-•-•-•---------------•-----••••----•-----•------_•--_.. -...--•--•-•-•---•••-----------•------------•-----••--•----•---------------•-------•-------------------------------------------- ---------•---•--------------•------••----•-------•--------------•-----•----•------------- •---------•------•------------------- -��---•--._.�..--------------------- ----------•----_-_---•-------•--------•---•-•-------•-----•------^^---• -`---- .............................................. _ FINAL INSPECTION BY:. -_�C.4js d`�--- �� -- ----------. ._. Date..----� 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 -9 145446 ATWOOD