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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) f 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 Ord7_�Z' No. 549. / 6- --------- = ------•------------- JOB ADDRESS AND OCATION....-- ---0------- -------------- .�_T_.__ � �� -------------------------------------- Owner's Name �,r ---- ----- -e- --- --- u)-------- ------ ------------------------- Phone-----------•------------------------ Address------------- Jq ., --------------- _ Contractor's Name----- --------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other El Number of living units: __ _- Number of bedrooms _3-- Number of baths .-f___ Lot size ___-__ZZ:C _____________________ Water Supply: Public system ❑ Community system ❑ Private ['Depth to Water Table j.5_0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Hardpan ❑ Previous Application Made: Yes ❑ No. _t[�New Construction: Yes 9--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic T k: Distance from nearest well`,- -.Q-___--__Distance from foundation___,f d-____-_-Material_II_e-._ !. _________________ p 7_2A)-.0----Size_ _M'r,� cie th__---�t�.' dd No. of compartments -- � � q p,� - - --------Capacity__ ----_---- Disposal Field: Distance from rearest well__SZ_ -Distance from foundation----2--d Distance to nearest lot line------ 7 �-y -- ---.Width of trench----Da--------------------- Type -" -- Number of lines______________af- ,.-._______Length of each line-------- _ ---------_-- Type of filter material-_-_/,5_-_ 5-tf,_-Depth of filter material___.-/g.-.__....Total length________�.-__f_____________________ vd r r Seepag Pit: Distance to nearest well_.________________Distance from foundation____--6__.-..Distance to nearest lot line__-�____--___ E Number of pits--_-____--/----------Lining material/t-L_C_�__--Size: Diameter-_--,, ._. Cesspool: Distance from nearest well-------- ------Distance from foundation__--_--------------Lining material-------------------------------------- 11 Size: Diameter--------------------------------------Depth---------- ------------------ ----------------------Liquid Capacity----------------------------gals, Privy: Distance from rearest well ___--_____-____-_-____-___Distance from nearest building------------------------------ Distance to nearest lot lire-,.------ -------- - ------------------------ -------------------------- Remodeling and/or repairing (describe):------MQ,�_f�_________ _ __ _ __ _______- -----------------------•---------------------------------•---- •---------------------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State and rules and regulations of the San Joaquin Local Health District. r-- (Signed) - ----- - ------------------------------------------------ -----(Owner and/or Contractor) BY� ---------------------------------------------(T1tie) _: --� ---------------------------------------- (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------^� REVIEWED BY DATE------------- -- - ------------------ --•------- BUILDING PERMIT ISSUED--------- ------- ---------------- ----------r1_1-------------------- ----------------------------- DATE--------- Alterations and/or recommendations:_____________-_-.-_--__--- -_. / - ---------•- --•-------------- ------------ ---------•------------- ----- ----------------- ----------------- l --- -'G` ' ----+ ------- ----------•---_- -- .-------_---. --------------------------•----•-- ---------- --------------------------------------------------------- ---- -------- --------- ---------------------------------------------------------- -------------------------------- FINAL INSPECTION BY ..... Date_ -- - c5� 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