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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 complia�n}ce,with Co my Ordinancq�No. 549. ! ^ JOB ADDRESS AND ATION--'; --- ------;- -'(�-.-i-U ------.......... . ---'..- .........----------•-------. Owner's Name------------ -"---------- ----- ---`------------------------------------------------------------ Phone-------"'.'�- ----------- . Address-------- t -• ---- •--••---....... - - ---------------------•------------------------•---------------------•--------------------------------.._..-•-•------- •--------------- Contractor's Name-- ------------------------_ -- - - - - ----------------------------------------------------------------------- Phone..........................-------- t� Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Morel ❑ Other Number of living units: .-r_ Number of bedrooms. Number of baths I--_ Lot size A5j0.. J_0' ------------------------• Water SuPPIY� Publics stem 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�ardpan ❑ c� Previous Application Made: Yes ❑ No Sand Construction: Yes ('No ❑ IN TYPE OF INSTALLATION AND SPECIFICATIONS: 0 (No septic tank or cesspool permute11 - blic er is available within 200 fe ) , Septic ank: Distance from nearest w ` itDistanf trom fo d �ion� Materiat !t=k p r?S Liquid de . h---- �T - -------Capacity No. of com artments-__. --- izj _K ��► �C.. t I Dispos 1 Field: Distance from nearest ell -_�Distance from foundation---`- 45j........Distance to nearest lot in�f T/'wr✓► [ Number of lines._...____. Length of each line____:_.__ __ ____.Width of trench___.._____ _`L'1_____________ t( Type of filter mated !{ epth of filter material �_ .Dlsta�c VTotal length--------- -� t/----- -I�' . I f d, rti'V See pa Pit: Distance to nearest well_ __ . __.Distanc f a�"] fpundatio �lto nearest lot line___�+ _. Number of pits__-___�________Lining material. _ _R. _..__ ._ ize: Diameter____.. _ _ ____Depth____._..-_,e�t.0�...._____.__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ El ___-__-_-___._-._-- .___--❑ Size: Diameter---------------------------- ---------Depth----------------•-------------------------------•---Liquid Capacity..-------------•---..----_-gals. Privy: Distance from nearest well _.----------------------------------------- Distance from nearest building------------------------------------------ ❑ Distance to nearest lot Ime ------ - ................................ ------- --------- •--------- Remodeling and/or repairing (describe)---------------------------------------------------------a...................... --••-----•-.................................................... �1 ------ ti N ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules d regulations of the San Joaquin Local Health District. (Signed) '2'�s��.t.�-• ` .Y ----------_------------------------------------ -----------------------------------(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 (� APPLICATION ACCEPTED BY. --------------------------------------------------------------•------------------------ -- DATE. --•--------------------------- ----------- REVIEWEDBY------- --- ------------------------------------------------- ......................... DATE..�;----------••------------------------------•---.---- BUILDINGPERMIT ISSUED---_---------------------------------_--------------............................................ DATE----"'`�-- Alterations and/or recommendations---- ------------------ --------------------------------------------•----------------------------------- .......... -------------------•-•--------- ------------------------------------------------------------------------------ -------•-----------------•------••••--•-••------•---•---------------•-•------------••-••------•---...-••--------•---•-••-•••---•....._......--- ---------------------------------------------..---------------------------- -----_..---------------------- -----------------------------------------------------------------------------------------------------•---•--•-- -------------------•.---------- •----------------- ------ ----- --- --2.. .-'----......-----.._....-_.---------------------------------------------- ---------'---•--•----- . ...... FINAL INSPECTION BY:. .......----------- 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 ES-9-2M 145446 ATWOOD 12-54