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4. APPLICATION FOR SANITATION PERMIT Permit No. r�. (Complete in Duplicate) 5�y Date issued ---------- -- -37 Application 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 Co my Ordinance o. 549. S � JOB ADDRESS AND L CATIO -- -- ---- -------- Owner's Name-------------- •------ ........................ --------- ------ -- Phone------------------------------------ Address-------------------------- ----- x...._--- �_-• � 1`! - �r�----•--.... ---•--........_. _..G . .y Contractor's Name-------- ------ -------------- Phone% #_ # `_./.. ! Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms .�=,2_ Number of baths l_____ Lot size ____ __Q - d_�----------------- Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table +�-�._Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes 0 No /New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ Distance ro u anon__/--S_.____.Vaerial-__`'__'_"!____. .No. of compartments_-___-_ ___-.__.____Size_ ._-.Liquid dep� / -_ Capaeity__ !f__h_____� Disposal Field-. Distance from nearest well __ _ ________Distance from foundation w'___-.--_-Distance to nearest of line.-��5-!___. �� Number of lines___._ _ ___Len th of each line____ o[...5....___.._.Width of trench_-____ ___�7 Type of filter materia/_ __ l�'J�'_Depth of filter material...,.__._._-_Total length------------------!X_�?__________-____ �. i Seepag i : Distance to nearest '�"ell_ -------------- -----Distant m fo dation___Z�.-____ stance to nearest lot line__--e47__ Number of pits--._._L-----_------Lining material_/:Size: Diameter___.� ---------------- Cesspool: Distance from nearest well_________________Distance from foundation---................ Lining material-_..--_-.__.---._-_-.______.___-_____. ❑ p ----------Liquid Capacity --------------------------gals. Size: Diameter--------------------------------------De fh-------------------...--------- - --- -- `L Privy: Distance from nearest well--------------------------------------------------Distance from nearesf building-----------------------..-------.-------- ❑ Distance to nearest lot line - - -----•--- ----------------------------------------------------------------------------- - --••---------------------- Remodeling and/or repairing (describe]---------- -------------------------------------------------------------------------------------------------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StaWkws, and rules and regulations of the San Joaquin Local Health District. r Si ned L W__ --- wner and or Contractor( g ) V *----- / l BY: - -- - -------------(Title)-- ----------------------------- - a (Plot plan, showing size of lot, location o system in relation to well uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - --- --------------------------------------------------- DATE----- -----------_------------------------------- ------ BY-------------------------------------- ----------- .- DATE-------------------•--------------------------------------- BUILDING PERMiT ISSUED---------------------------------- DATE---------------___- ' Alterations and/or recommendations_______ ________ �_ - ------------- 11_ - --------------------- --------- - - r ---------------- ---------------------------------- ---------- - ------ -- -------- ------------------------------------------------ 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-9 ,4sa46 ATWOOD