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APPLICATION FOR SANITATION PERMIT Permit No. .., y�.��.__.. (Complete in Duplicate) Date Issued Applica}ion is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ith County Ordinance N . 549. JOB ADDRESS AND LOCATION--- ---•-•-•----- --------•-----••---•--------•-------••---------------------- Owner's Name------- •-------- ---------------------- Phone.------------------------ Address-------------------- - -------- _.. ._.. -e-�--�-------------------- Contractor's Name------------ ------ t'^ 4_�- --------- �_ Phone Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____j___ Number of bedrooms_ Number of baths _1____ Lot size ----_- d_Q._X_..15 __________________ Water Supply: Public system ommunifiy system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yeso ❑ New Construction: Yes �.—i`to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.) hr r Septic Tan Distance from nearest wells✓-CV.Lkw_Dist c from foundation_-._1_�,-�__-._ _ - �� " - --.Mat real-��--------- --=---�- ------------------ No, of compartments-__---_-- �______Size _ ._'�_ _ __Liquid depth________c_�___------Capacityr�C _ Disposal Field: Distance from nearest well_ ,-�4,t,_Distance from foundation1_0-------___.Distance to nearestlines r._ [ /! Number of lines___._ __. __ Length of each line--------_ - t ?Jidth of french.__.______----!,_L ________________ Type of filter material__ _ _:Depth of filter material_`_.,�__a----_____..Total length---------/f��______________________ Distance from f ndation__ f See pa ;f Distance to nearest well.. __: �_ '___.- nce to nearest lot line_______ Number of pits-------- ._ ___._Linin matertal___51r .. _ _ Size: Diameter.___ __ � - Depth__.._._ 4_!_____________ p �� g �' u 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------------------------------------------ ❑ Distance to nearest lot line-------- ---------------°•-=--.-----------------------------------------------------------------------------• -•------------------------------- Remodeling and/or repairing (describe)-----------------------------------------------------------------------------•-------------------•---------------- --------------•----------------------------------------------------------------------------------------.------------------------------------------------------•--------------------------------------------------------------- ----------------------------------------------------------------------1------------------------------- ----------------------------------------------•-------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rule an gulations of the San Joaquin Local Health District, ti (Signed) ---- --- ------_-•-------------------------Awner and/or Contractor By:................... . ... .. ---------- ----- ------ - Title,---------- - ------------- -. (Plot plan. showing size of let, location of system in relation to wells, buildings, etc., can be placed reverse side,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -------------------------------------•-------------------- DATE------------------------ --------------------------- REVIEWEDBY------------------------------------- .----------------------------------------------------------- DATE---------- BUILDING PERMIT ISSUED----------------------- --------------------------------------------------------------------••-- • DATE---------------� Alterations and/or recommendations:�7� ---------------- -/L'P'L G-- --------•-•--------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------.---- --- ----------------- ------------------ ------- FINAL INSPECTION BY: .tit. O Date.- �� 4-v � J /-------------------- SAN JOAQUiN, LOCAL HEALTH DISTRIC 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 145446 ATWOOD