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IV APPLICATION FOR SANITATION PERMIT Permit Na. __, �1--..------ (Complete in Duplicate) 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 Ordinance No. 549. p� ------------------------------------------------------------------------- " ------------------------- JOB ADDRESS AND LOCATT.LON-._____----FZ/---- IF- Owner s Names - -- -------------------------------- -------- Address-.---------------------- �� d 9------ Address------------------------7`-�c"5�__A ---------- ---------------------- i�11 �F yrPhone9G G� Contractor's Name--------------------------------- - ------------ -- ----- ff- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 47J Number of living units: /. Number of bedrooms -- Number of baths __`_. Lot size ------ _._4__� :�- "_-- - '77 w..... "* - . Water Supply; Public system E-1Communitysystem El Private � ____ epth'to Water Table ___ ft- . a's � Wa Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well ______________Distance from foundation__.__.______..-----.Material______._-___._..____.___--_________-.._______.__. ----------Liquid depth--------------------------Capacity No. of compartments Size -------------- spos I Fad: Distance from nearest well__..__.___....-Distance from foundationDistance to nearest lot line_________________ ,L Number of lines----------------------------- -----Length of each line---------- -----------------_Width of trench-.----------------------- --------- Type of filter material-------------------------Depth of filter material`--------------------Total length--------------------------------- Seepage it: Distance to nearest well e"UA�__7-Distance f• om foundation---�Q____._._.Distanc2 to nearest lot line---s ________ J --- Depth Number of pits-------/-............Lining matenal_.�.- ----Size: Diameter__.___ ___ __ Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material_._______ _--------- "- ---- - ] --------Depth--- ---------------------------- ❑ 5ize: Diameter-------------------------- - Liquid Capacity----------------------------g \ ' Privy: Distance from nearest well------------------------------------ --------- --Distance from nearest building---- -------------------- ----------------------------------- 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}aws, and rules andregulationsof the San Joaquin Local Health District. ` Owner an Contractor)------ ------ ! �� f---- - r�----------------------(Title] • -------------------------------- ------------ BY° ;"" �._ Y g be placed on reverse side). (Plot plan, showing size of lot, location of system m relation wells, buildings, etc., can FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------------------- - " -------------------------------------- DATE.�,-—------------------------------------------------- --- DATE -- REVIEWED BY ---------- - ------ ------------------------------------------ DATE__ BUILDING PERMIT ISSUED--------- ------------------------- --------------------------------- DATE.-----. -------------------------------- ---------------- ------------------ Alterations and/or recommendation-------- ------IF------------------------ ---------------------------------------------"�---- --------- - ' - - -------------------••---- •---------•------ ------------------------------- -----•--------------------------------- ------------------ -------------•-------- --�---'�-.>�(�`_. �------------------ ------------- FINAL INSPECTION BY:_...7.sf---!� ---------------------" ------------- Date-- SAN JOAQUIN LOCAL. HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 Wast Oak Street Y Tree California Stockton, California Lodi, California Manteca, California Y. E.,--9 145445 ATWOOD -