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APPLICATION FOR SANITATION PERMIT Permit No. .- ---_--__1I_VV_-..-J-.___ (Complete in Duplicate) Date Issued ---------- k Applica4-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. ten. JOB ADDRESS AND LOCATION------- �� --------- V --------------- '...... --- - -------------------------------------------------------------------------•------------ Owner's Name--- ` =- ' Phone .�r �. Address......- ---*-------•-----fit/4 - - !` - Z .,4 Contractor's Name-- � -` = " 4 —1 r. t,- • Phone. Installation will serve: Residence d Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- Number of Bedrooms --- Number of baths ---- Lot size ---------:�----------------- - ' '7 K`------------- Wafer Water Supply: Public system ❑ Community system ❑ Private M, Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan 0 Previous Application Made: Yes ❑ No M New Construction: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank... Distanceyfromynearest well__,..............Distance from foundation----------------..-Materia!__-_.-----_-.---------_---___.--_.--_-----------. No. of com artments_____.- --- ------- -Size--------------------------- ---Liquid de th_-.---.---.-..--.-- Capacity DisposalFieid Di ftqn ,from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.---------------- El Number oT line3-----------------------------------Length of eachline-----------------------------.Width of trench----------------------------------- Type of filter material---- -Depth of filter material-----------------------Total length.__--------_--------------------__-__.--.- Seepage Pit: Distance to nearest well------ -------Distance from foundation------ �"____---.Distance to nearest lot line------'�---_---- ❑ Number of pits-------!--------------Lining mate ria l- 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------------------------------------------ O ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------•--------- ------------------------------ Remodeling and/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, State laws, and rules.and regulations of the San Joaquin Local Health District. I •` ' ✓� (Signed ----__-Owner and/or Contractor B4 ---------------------------------- -------- --•------------------ -------------------------------- Y•----.:_.�•-•'---•-••--•-•--------------- _[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------------- BUILDING PERMIT ISSUED------•---•--------------- -------- ---- --------------------------------------------------------- DATE---- ----_--- -------/-------------- ------------------ Alterations and/or recommendations-------------------------- -5�--------------------------------------------------------------•-----------------------•--��- S--------------------- ------------------•----------------------------------------------------------------------------------------- -------------------------------------------------------------------- ....----------------..-_---------•---------- ------------------------------------------------------•-------- ------------------------------------------------------------------------------------------------------------------------------------•-----•- •---------- ------------------------------------------------ ---------------------------- ---------------------------------------------------------------------------------------------------------------------------•------------------ ��` - _ �--- 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 E5-9-2M 145445 ATWOOD 12-54