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1 ��I APPLICATION FOR SANITATION PERMIT Permit No. _. (Complete in Duplicate) Date Issued --- Applica{lion'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 OrclinqAceNo. 549. I JOB ADDRESS A OC TION____:_._ v�3 i ----- - -- --- ---------------------------------- Owners Name_.___ __. ----- -- -- ----------------- Phone. _.. Address '" ....P------------------- -- -- ----------------------------------------- --------------- -•---•--------- --•-----•--- Contractor's Name______ _ —�60 -- -- ---- -------- ----------------------- ----------. Phone-------- -----------------7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __./ Number of bedrooms s�_ Number of baths --4.- Lot size __-___ _._�.' �a_O . Water Supply: Public sysem Community system pp • t y' Y Y ❑ Private ❑ Depth to Water Table$7� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [-] Clay Loam E] Clay C1 Adobe Hardpan ❑ Previous Application Made: Yes- TYPE New Construction:.Yes ❑, No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Tank: Distance from nearest well------------------Distance from foundation--------------------No. of compartments----- -----------------..Size--------------------------------Liquid depth- ------- Ca acit Y--------------------•- D' os I E Id: Distance from nearest well_________________Distance from foundation to nearest lot line__________-___... L�r Number of lines---------- —n I ----------�-------- __--Length of each line------------------------------Width.of trench_..._-----------____-_ Type of filter material._.__...___..________._Depth of filter material_______________----_--Total length______-___ rte, _ _ � ---------------------- Number ------- Seepage Pit: Distance to nearest well_: 4 � Distant ndation__-• -- --- Distance to near st lot lidWs'- -7--Lining .. Number of pits----•-- ------ material'-., --Size: Diameter----,. .._-Depth. Cesspool: Distance from newest wellf _______Distanee�rom foundation---.----------------Lining material__._______ ___- --------------- 0 Size: Diameter------ -- ----------------------- ----Depth--- - ---------------------- ------- Liquid Capacity--------------------- �� 9a � Privy: Distance from nearest -_---------------------------- Distance frrim nearest building •---------------- ❑ Distrnnce to nearest lot line___-----------------------r , -- ----------------------------------------------------- Remodeling and/or repairing (describe)------------------------ , - --------------------------------------------------------------- --------------------------------------------------------•------ ---------------------- --•------------•--•-------'---------------- ------------•----------' ----•-----•-----------•-----•-----•--------------------------•-------•- I hereb ify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, ate laws; and rules and regulations of the San Joaquin Local Health District. (Signed)------- -- - -- - - ----- Owner and/or Contractor) BYE ---------- --------------- - --- {Title- ---------- ------------------------ ----------------- n plan, showing size of lot, location of system in lotion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------- ---------__-_-- DATE- REVIEWED - ---------------- ------------------------ - REVIEWED BY ---------------------------------- --------------------------------------- DATE----------- ----------- BLIILDING PERMIT ISSUED-------------------- -- ------------------••---------- -- -------- --- ;------------------------------------------------------ -- DATE---- -- Alterations yrs and/or recommendations:.________..._._-`--v ----- ------—-- -------- IJ. --------------••--------_--' ,----_ ...---•-------•-•-----:--•------ ------------------------------------- --------------------------------------------- ---------------- FINAL INSPECTION BY_ g;,U__r_______ 1 '// V\ Date....._ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Stree+ „ 814 North ”.C Street Stockton, California Lodi, California Manteca, California _ Tracy, California ES-9' 145416 ATWOOD 1