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� ,16 APPLICATION FOR SANITATION PERMIT Permit No. . 7 (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. -' This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_----------�2 •-------------- - s / --------•------------- -----------------------------•-------------- Owner's Name it _ -�'a7L----------------- -� el,' ` ------------------- -------- -- Phone ----------------------- Address..-•--------- ._` ._..._... 5i__0 .`r' .. ------•--------------•------------------------- ------- --- ---------- - -------- Contractor's Name...-- �k..r� trr: ------ ---------w- n� ------------------------ •----- --------------.-- Phone Installation will serve: Residence I2 Apartment House ❑ Commercial ❑ Trailer Court 0 Motel [❑ Other ❑ Number of living units: 1------ Number of bedrooms __ Number of baths ---/--- Lot size Water Supply:Supply: Public system RL Community system ❑ Private ❑ Depth to Water Table,_ . ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: Yes No PP ❑ ❑ New Construction: Yes ❑ No Q 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-----------------Distance from foundation-------------------Material ❑ 'iJo. pfAcompartments--- ------------------Size--------------------------------Liquid depth----- - --- - ----Capacity------ --- --------- Disposal Field: Distance from nearest well--------------_-Distance from foundation-------------- _____.Distance to nearest lot line---------------- ❑ ''� umber of lines-------•--------------------------Length of each line-----------._-------. ____._.Width of trench____.________________ Oe ------------- Type of filter material------------- ---------Depth of filter material-----------------------Total length_______________ Seepage Pit: Distance to nearest well...... ��-ph.t.Distance from fo � undation____, ._O.e-.Distan a to nearest lo,` line----1 ` _�___ Number of pits------ ______________Lining material�-�.__ ?�cSize: Diameter._.. _F.-.___Depth_____` ---.- --.- 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----------------------------------------- Distance to nearest lot 6e---------------------- - Remodeling and/or repairing describe)________________________ ---------------------------------------•--------•-----------•----------------•--------------•-----•----------------------- ------------------------------------ ----------------------------------------•--•---------•-•----------•----•----------•---------•--------- ----- - - - - ------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District. (Signed)-., - .... --------------------- --------.- --- ------(Owner and/or Contractor) - - ---- - - - - { ------r7;___f ------ ------------------------(Title)---- "._. (Piot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ----- -:- ----- ------ -------------------------------------------- DATE------ .� REVIEWED BY - DATE ---- ----•--------------••----------- ----------------------------------------------------------- `\ BUILDING PERMIT ISSUED------- ------------------- -- DATE.. ----------- Alterations - -----••------------- ----------------- ------- ----------------------- A terations and/or recommendations---- ---------------------- - --------------- _.__. >• ' ---------------------------- --<< -•--- ---------••------- aa - --; -------------------------------•-•-----------•-------•-------------.--------•--•----------•-------------------------- `� ------------- ----------------------�----- -------------------------------------- ------------ --------- •--- ---•- ----------- - FINAL INSPECTION BY:-- ----- `-' 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]-2M 145446 ATWOOD 12.54