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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 Ordinances No. 549. 10h JOB ADDRESS AND LOCATION--- - -----------� �!* ------ • Owner's Name �� == G?1 - Phone Address............... Contractor's Name - ---------- - --- ---- Phone----------------------------------- Installation will serve: Residence 13""Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __C---. Number of bedrooms _ ' Number of baths ..t__ Lot size _. ____••-___-- Water Supply: Public system 93-"Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe1!1---gardpan ❑ Previous Application Made: Yes ❑ No [r'"New Construction: Yes ❑ No Hg-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sgpt' Tank: Distance from nearest well_________________Distance from foundation__---_-_-_-_--__-.Material------------._.__-__--.-_-_._-_.___._.__-_-----•. No. of compartments------------------- -----Size-------------------------------Liquid depth--------------------------Capacity-_------------------- D' ------ Disp .Field: Distance from nearest well_________________Distance from foundation_.____............Distance to nearest lot line................. Number of lines...... Length of each line_------ZP-..__...__-_.._.Width of trench..._.., ___.___._.____-_Type of filter material� � length� of filter mate naL_�,�.__._�__._Total _._.___,,��__________________________ 'Seepage Pit: Distance to nearest well__4 `g___Distance r�o/m fojn tion__/__ ..._..Dista ce to nearest lot line_4�_._._ Number of pits----I_-_-.__-.--_.-Lining maferial--?LU _ __ _ . ize: Diameter_,' _._._-_._-_Depth-----„�Q--_'.__--_-_--_-__ 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 --------•--------- ---------------------••---------------------------------- Remodeling and/or repairing (describe):_---------all. ----..---------------------------------------------------------------------------- -----------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------•-------••------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.................... 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 r9sulations of the San Joaquin Lpcal Health District. (Signed) ---------------` (�`"rn.►. ..,,r�Z.,. Contractor) By:.................. . ..... -Y ---- ` --------(Title).. -------------- (Plot plan, showing siz lot, location of system in relation to wells, buildings, etc., can be plac�re e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ----------•--------------------------------------------------------------------- DATE.' .------------------------------------------------ REVIEWED BY---------------------- - ----- -- ------ DATE--M...-•-------•-------•--------...................... BUILDING PERMIT ISSUED.------•---- ------------------------------------------------•-----------------•----•------------ DATE-----7K----------------- -------------- ............... Alterations and/or recommendations:_----------- ......__----------- •-Z -------- � ----------------------------•---------------------- ---------------------------• -----------'--• --- - -----.-.---------- - -- . ---•-••----•--•--•-•.----..... FINAL INSPECTION BY:.....:9:1 - - .a�'S '•� ---------------------•---------....--- Date.-----a�------ ------ ----------�------------------•----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street S+ockton, California Lodi, California Man+see, California Tracy, California ES-9 145446 ATWOOD