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t APPLICATION FOR SANITATION PERMIT Permit No. ..-.__��-..._..__ . I (Complete in Duplicate) 3 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 Ordinan o. 49. c JOB ADDRESS AND LOCATION.,.J_/i1 �-----�---- ------- --------- -- - -----/ --------------- Owner s Name-------- -- -- ----------------------------- Phone--- ------------------------------- Address ryj------- '� ,r -- ----- - ------• ------------------------------------- Contractor's Name--------- - - - - ----- ------------- --- -•- - -- -•--- -- ----- ---- Phone_llC' _.G!_ � - -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _22' Number of baths ----1__ Lot size ----ZC5—-Al,i--____________________.____ Water,Supply: Public system Community system ❑ Private ❑ Depth to Water Table Azk a.i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(g�_Hardpan ❑ Previous Application Made: Yes ❑JNo Z_ New Construction: Yes EI.,, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-________________Distance from foundation--------------------Material---------.-------------------------------- ,_.. ❑ fir ,.. . of comparfmienfs ----------------- ----Size---------------------------------Liquid depth--------- -- - ----------Capacity....................... Disposal i ield; Distance from nearest well-----..... ------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ er of lines ---------------------- ---- Length of.each line------------------------------Width of trench----------------------------------- Ty e of filter material-________________________Depth of filter material-----------------------Total length______________________-_---_______________ Seepage Pit: Distance to nearest welf_.,V. _0_—PZC__-9istance from foundafion___,��.... _ �� Distance to nearest lot line____. {dumber of pits_____-/_.___.....__Lining material_= '� Dia meter___.�r� p T I Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material--------------------------------------- w ❑ Size: Diameter---------------------- -----.Depth----------------------------- ------------ Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------- >_— ---------.------.,---Distance from nearest building-------------------------- ------------ ❑ ---- .-- Distance to nearest lot line---------------------------•- ----------------•--------------------Y-------'-----�'-�-`--�--='--=-°------------ --=- --------- Remodeling and/or repairing (describe):-------- - ------- --------------------------------------------------------------------•--•--•-•------------- --------------------------------------------------------------!-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- --------------------------- --•---•--`•--•--------------•------------------. -•-----•---------------------------------------- -----------------------------------------------------•-----------------------•---------------------------- ------------------------------------------------------------------------•--------------------------------I------ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Sta s, and rules and regulations of the San Joaquin Local Health District. (Signed)----- ---- --- ---- ------------ -------------- --------- ---------------------------------------------------------------- ---------------- (Owner and/or Contractor), By:- ----------------- - -- -------- ---------------------------(Title) ------------------------------------ (Plof plan, showing size of lot, location of system in relation+o wells, buildings, etc., can be placed on reverse side). 4 I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------- DATE------- ---•------------------ -------- -------------------- REVI EWED BY-------------------------------- ---------- DATE-�`�-" = -,', ... ......... BUILDING PERMIT ISSUED----------------------- AA --- ------ --------------------------------------------- DATE------------------------------- -- ------------------ Alterationsand/or recommendations:--------------------- - ---------- ----- -- --- ------------------------------------ - •-•-----•------------- ---•--------------•------•----------------------- I ---------------------------------•---------------------------- ------------------------------------------------------------------------------------------------------•-•-•------------•----•-•------ I t FINAL INSPECTION BY:---- .!....'--" --- Date--.,3------------------------------------------------------------I;w ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-55