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APPLICATION FOR SANITATION PERMIT Permit No. ... .2- --�--- �� ' J (Complete in Duplicate) y r- Date Issued3 0 A��iplica-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 Ordinance.No. 549. -� ,... JOB ADDRESS AND LOCATION-----2.S--c '. V_t_.N4- ----- -------- �--`` / ,,L-------------------------------- -- ------------•---A Owner's Name _ � ...- -- ------- ------ Phone. _ U - ------- -------------------------------- Address.' - � °� � G '. Contractor's Name. 4 -cy-vs f�--� -------"--------------- --------------------------------------------------- ---.._ Phone------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailet Court ❑ Motel ❑ Other ❑ Number of livingunits: _._ _-- Number of bedrooms __._ ..42--Number of baths I_._ Lot size ------------ - - -----_------------------- Water -_-J�.S:D - ---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobelK 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.) Septic Tank: Distance from nearest well- !T r _ Distance from foundation'. ------' -----M�ate ial- - -------- '- _No. of compartments.____--__ .--------Size__ - --- _._ p ____- - Capacity r. Disposal Field: Distance from nearest well-------....Distance from foundation-_-_ ------.Distance to nearest lot line-----<4 . Number of lines-,------------------------- _ ----Length of each,line-----------:.60--------Width of trench------------_g- Type of filter mate ria lsvccly-_4 epth of filter material--__.____f _---Total length------------------------- ��- �„' Seepage Pit: Distance to nearest well_______.__.-----_____Distance from foundation_-_____---__�--___.Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --.Depth--------------------------- Cesspool: Distance from nearest well___-._-__.____Distance from foundation.__-{..............Lining material-----------_ .._______._-______._. ❑ Size: Diameter--------------------------- ----------Depth------------------------------------------ ------Liquid Capacity------------------- gals. Privy: Distance from nearest well.______________________________.--------------Distance frorm nearest building______-._-__-_-___-__.____.____l . ❑ Distance to nearest lot line______ Remodeling and/or repairing '(describe):---------- ----------- ----------------------------------------- -------------------------------•...............................---•-------------------- ------------------------------------------------------------------•-----------------------------------------------------------•-------------------------------------•----------- - - v ----- ---------_--------------------------_----------------------------------------------------------_----------------------------_----------------------------------_---------------_"'i'...........-----------.--_._---_.-._.-____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and r s andregulations of the San Joaquin Local Health District. (Signed) f 9 ) ... az ----------------- ------------- ---------- ------------------------------- ----(Owner and/or Contractor) ------------------------------------------------------ -----------------------------------------(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-------- � -� REVIEWED BY --- - - ------------ ---------------------- ----.- DATE---------- --------- ` - --------------------------------- UILDING PERMIT ISSUED ----- --------------------------------------------------------------------- DATE Alterations and/or recommendations:_---------------------- - - ----------------------- ---------------------- ----------- ------------------------------------------------------------------------------------------------------------ ----------------- --------------- ---------------------- ---- ---------------------------------------- ------------------- -------------------------------------- FINAL INSPECTION BY:-- 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