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I' APPLICATION FOR SANITATION PERMIT Permit No. ... .......... (Complete in Duplicate) Date issued --- AAplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 49. JOB ADDRESS AND LOCATION � f - --- -- ---------------------------------------------•--------------------------- Owner's Name-__-- _ - - -- ............. Phone-- ____.a__T`P_'__ . Address----- --------------------- --- ------------ Contractor's Name----- ------ -- -- ---- --------- -------' ri------�-&---.7"'—'--•--•----•-------------------------- ------ --------- Phone--rte...-~- R Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms __ Number of baths _/-____ Lot size -----''�+___._-_ ,,,__-------------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table--Dft. Character of soil to a depth of 3 ft: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1Vf Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) i Septic Tank: istance from nearest well_________________Distance from foundation--------------------Material____________.__.__.____________--___.________.__. ❑ of compart{merits--------------------------Size--------------------------------Liquid depth--------- --------Capacity---------------------- ,Z; Disposal Field:�Typ e from nearest well...........:.....Distance from foundation------_:_---._.___.Distance to nearest lot line---------------- ❑ r of lines-----------------------------------Length of each line--_-----------------------._.Width of trench----------------------------------- f filter material---------------_---------Depth of filter material-----------------------Total length__________________-_._--_________-____-.._ Seepage Pit: Distance to nearest well-A/1-hp„�-Distance from aundation___-3Q____.-.Distancerto nearest lot line----- Number of pits________ ____________Lining materialC-C_: ze: Diameter__. _,'_______.Depth____ ,_, `___.________ 9 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__________.__.___________-___..____-_____. i ❑ Distance to'nearest lot line_________________________ O Remodeling and/or repairing [descF ibe] -------•---•---••---•-------- F ------------ --------------------------------------- ---------------------------------------- ------------- -------------------------------------------------------------•-------•------------------------------- --------------------•-•-------------"-----------------------------------------------------........---------•------•-•------------------_----------------------------------------------------------------------------------- I hereby c that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to la s, 'and rules and regulations of the San Joaquin Local Health District. I (Signed)--------- --• --- - ----- ---- ------- ------ -------- ------ �`. �------------------------------------------------------------(Owner and/or Contractor] By:. .. ----#-- ---------------------------------(Title)--. ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_� - -- ------------------------ --------------------------- DATE_ --------------------- --------------------------- ------------------------ --------- -- - REVIEWED BY --------------------k- --- DATE__ BUILDING PERMIT ISSUED------------------------------------------- ------ -------•-•-----------------•---- ------------------ DATE------�''------------------------------ - -- -------------- Alterations and/or recommendations: = --------------------•--------------•--------._... �. -------------------•--- ---------------------------------------------------•----------------------------------------- --------- ------------------------------------ ----------------------------------------------------------------•---------- f �'ii-. Date �-�-------��-- FINAL INSPECTION BY:---------------------------- -. I ----------------------------------- 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 E5-4-2M 145446 ATWOOD 12-54