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• APPLICATION FOR SANITATION PERMIT Permit No. 8 S Z (Complete in Duplicate) I }`I' • (Com p Date Issued ........2V 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. 7V- 333 JOB ADDRESS AND LO ION.--------- `......---`-D7- 5- ' ..........................................................------------•-•-------•---- Owner's Name.......... t�G�-�--•--1._--.-_.--- ----------- ------------------•----------------------_- Phone-/`�-9--------*------------ Address---------- .... . ------- ... - -�/_....................•-•----- Contractor's Name______________ Phone.l�___._....__. _ Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms _ Number of baths J... Lot size ____ 50./.,XIDO!-----__--•------_-- Water Supply: Public system ❑ Community system ❑ Private [g/Depth to Water Table /A_ ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q_"Hardpan ❑__. Previous Application Made: Yes ❑ No [2000'New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - 4,srosa7F ti Tank: Distance from nearest well.......____._.__Distance from foundation------____________.Material-__________-_.-.-___-_-__________-_____-_____. No. of compartments-------- -----Di--- Size --------------------------Liquid dep�h---------- Capacity-_------------------- P ield: Distance from nearest well_____._._-Distance from foundation.__.,R_�........Distance to nearest lot line_______ _______ Number of lines---------- Length of each line......7�F7..___..y�_....Width of trench___ _��_________________ Type of filter material__S�_ 4G .._Depth of filter material._____1g.____.•__Total length_______? __________________________ R Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- rarj� ❑ Number of pits______________________Lining material_-------------------- Diameter__--______-....___--___Depth_ ._____..__-.:_-__._____-______ W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------_.____-____-•.________. ❑ Size: Diamefbr----------------- ---------Depth----=--•-----------•----------------------- --------Liquid Capacity............................ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--.------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---- ---- ------------------•-•----------••---------------•--•---------------------•-------- ........................................................ ---•------------------------•------------_•----------_•--------_•------••----------------------------------_--•----------•----....................................................................---_---__-•-------_----- ---•-----------------••-----•-------------------------------•------•------------------------------•----•-----•--------------------------------------•-------•-•---•----------------------._._•--••--•-••--•-----••--•....-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat and rules and re tions of the San Joaquin Local Health District. (Signed) ____ __________ ------*.....__________________ (Owner and/or Contractor �� ,f -e- ------------------------------------------ By: - � h - ------------------------- (Tale) (Plot plan, showing size of lot, locat44 ion of syst m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_�-------------------------- ---------------------------------------------------------------- DATE....j_; ------- - ----------------------- REVIEWED BY-------_--------------------� .: - ....... DATE-- ---••-----------"•------•------- BUILDINGPERMIT ISSUED . .._-•----------------------------------•--------------------------------------------- DATE- . •---------•---••------•-----•----------•----_--•-- Alterations and/or recommendations: --------------- -------•------•-------------------------------- ---------------------------•----------------------------- ---------- -----------------------••-------------------------------------------•---•---------------•---•----•-•-----•----------•-------------•- -----•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-- --------------------------------- --------------------------------------------•--------•---------------------------------o----------__.---••-.........------------------------------------------------------------------------------•-----------.._----------- --------•••• ----------------- -------- --------------------------------------- f� 3 r`a FINALINSPECTION 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 E5-9-2M 145446 ATWOOD. 1$•54 ,