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C31 APPLICATION FOR SANITATION PERMIT Permit No. S (Complete in Duplicate) Date Issued gA plica+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. I�K -------------- JOB ADDRESS ANDC ION---------- -----------41e------- ------------------------ 2-/Y Owner's Name------------- - -- ----- ---------2-------------------------------G-'-- ----------------- ---------------------------------------- Phone------------------------------------ ----------------------------------------_......... Address..-------------- ------------------/ ---------- ----------- --------------------------------- ---------------- Phone..--------------------------------- Contr I actor's Name---- 04 Installation will serve: Residence M Apartment House EL Commercial C] Trailer Court ED Motel [] Other E] Number of living units: _��___ umber of bedrooms ._,Number of baths ----10--t.-O-t size -----Zo-a---�.Z4 ----------------- Wafer Supply: Public system R_Communify system El Private E] Depth to Water Table Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam El Clay Loam El Clay D Adobeq Hardpan E] Previous Application Made: Yes El No EL New Construction: Yes E1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: -D'sf nce from nearest well_________________Distance from foundation----------- -----Material--------- ----------- r ---- -- ----- --------------- El compartments--------------------------Size--------------------------------Liquid depffi--------------------------Capacity------ --- ------------ Disposa�lllr'ielcl: ,Diss ante from nearest well_________________Distance from foundation---------_--------Distance to nearest lot line----------------- er of iines-----------------------------------Length of each line------------------------------Width of trench----------------- ------------ filter material-------------------------Depth Ty of filter material----------------------.Total length------------------------------------------ Seepage Pit: Distance to nearest well_._14e_"x'T,1-v_Distance from foundat'ion__Zd_.__/_____.Distance to',,nearest lot line__-------- Number of pits____{______________Lining material......4&4G�ize., Depth- ___-_-______ Cesspool: Distance from"nearest well-----------------Distance from foundation--------- -- --- Lining material__..__________-____________________- \ ❑ aterial-------------------------------------- El Size: Diameter---- ---- ------------------------- Depth----------------------------------------------------Liquid Capacity. -------------------------gals. tl� Privy.. Distance from nearest well------------ ---------- -------------------------Distance from nearest building_____...___._._______________.._-____._. El Distance to nearest lot line---- ------------ -----------------------------I-----------------------I--------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------- ---------------___--------------.........____------------------------------------------------ ----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------:----------------- --------------------------- --------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- ------------------------------------ -----------------------I------------------------------------------------------._......-----•-•--..............I------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. jn�y ' -- -----------------------------------------------------------(Owner and/or Contracfo --- -- ----- (Signed)--- .*------ By:__ -—- ----------------------------(Title)--------- ----------------------------- --- (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-----ii—------------------------------------------------ DATE-------------- REVIEWED BY----------------------------------- ------- --------------------------------------------------------- -------------------------------------------- BUILDING PERMIT ISSUED----------- DATE_ ------------------------------------------------------------- Alterations and/or recommendations— ........ .................... ------------- ------------- --------- ---4------------------ -- - - ------------------ -------------- ------- - ----------- ......... ------------- ...... -------------- .....—------ ..... -------------------- ......------------ ------------------------ --j------------ ------------------------ ------- - -------------- -- ---------------------------------------------------------------------------------------------------------- ------- ---------------------- ------------------------------ ---------------------------------------------------------------------- -- ------* - ----------------------------------------------------------------------------- FINAL INSPECTION BY:--------F-6-t,� - ---------------------- Date....--- - ------- - --- --- -------------------------------------- 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 145446 ATWOOD