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1(� Permit No. .o ( APPLICATION FOR SANITATION PERMIT �j (Complete in Duplicate) Date Issued Applica}ton 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. 54.9, d JOB ADDRESS AND LOC TION- -- ---------- - /`� (} Owner's Name------cF -------- ---- ----- = Phone r s - Address...----••. -•---- --- ----- ---------- - L ------- --------------------•-------------- Contractor's Name k - -----------------------------•--------- Phone. �t__Z0d-7 -- ------ Installation will serve: Residence.®._Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�__I Number of bedrooms --Z--Number of baths . _:.:- Lot size ------/4` _.__�C�u ------------------- Water Supply: Public system ❑; Community system ❑ Private ❑ Depth to Water Table _(9K1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E10 Hardpan ❑ Previous Application Made: Yes 0 No Q 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: istance from nearest weii-------___________Distance from foundation--------------------Material-------------------------------------- ----------- 0 0 of compartments---------- ---------------Size--------------- Liquid depth- Capacity Disposal Fie] :* i ante frominearest well-----------------Distance from foundation------------------__Distance to nearest lot line._..-_____._____. ❑ Nu er of lines-----------------------------------Length of each line.-.--------.--- ----...Width of trench---------------------_ ----_----- Type of filter.material-------------------------Depth of filter material-.-..--- --------------Total length----------------------------.-�-- ----..- 11 1 Llistance 0. .. o nd„tion____ ____-.€Distance o nearest lot line.__ - _(�____ Seepage Pit: Distance to nearest well_____. - . �• f p Number of pits---------I------------Lining material_..- ---- Diameter__--- --_-De tn,_._ ------------------ 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 line-- -------------- ------------------ ------------------------ ------------••------ --------------------- ------ Remodelingand/or repairing (describe);----------------------------------------------------------------------------------------------- -------•---•-----------. ---------------••----- ! --- ---------------------------------------------------------------------------•-•---------------------- ;I I hereby certify that,l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate ws; and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ------ ---- --- - - -- - ----------4----=-------------- -- -- --------------------------------------------------------- - weer and/or Contractor I••- ----------------- -------------(Tit - By:---- `�"�`- u” (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------- ----------------- ------- � ---------------------------------•------------- DATE--------�J�___---.`-------------------------------------- REVIEWEDBY------------------------------------------:-------------------- ----- ------ -------------------- •------------------------ DATE-------------- -- -- BUILDING PERMIT ISSUED------------------- ---- -- ------ DATE.. --------- . `� Alterations and/or recommendations:------- ------- ------ ----- ---- ---••---------•------ •------- --•------------•---•- -�--- - -- - - --------------------- ----•- ------ ------- -------- ------- ------------------------------ --.- ------------- ------- -------- ------------------- - ----- ---- ------- -- --------------------' FINAL INSPECTION BY -- -- --- Date ..................... l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California r Lodi, California Manteca, California Tracy, California EE-9 145446 ATWOOD