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- ' APPLICATION FOR SANITATION PERMIT Per mit (Complete in Duplicate) a Y �s/A Date Issued .--e.---�__ -_ Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install tate work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION_A------------- - ? 9 Owner's Name ----- - -•--- � -----------------•-•------------------------------- ---------------------------------------- __A V------------------------ -- ------------------ ----------- .- :;7 : --.Phone- - f VAddress--- 1 - Contractor's Name--------------- �- --- ______ ,�,� ---- --• ---- -------- Installation will -serve: Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .- - Number of bedrooms - . Number of baths --/ fs'" ' _- Lot size .----- Supply: Public system - - ----------------------------------------- Water y Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®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.) " epti Tank: Distance from nearest well------------------Distance from foundation-_---- -------------------:Material- :. No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity------ - ----------- DispieId: Distance from nearest-well--------- ------ Distance from foundation--------------------Distance to nearest lot line__----- sjt el Number of lines--7------------------------------ Length of each line---------------------- Width of trench---------------------- - Type of filter material->----------------------Depth of filter mater`ial---_----;--.-----------Total length------•----------------------•---- ------- Seepage Distance to nearest well_ ��Distance from foundation----_�d_�-- Distance to nearest lot line----_` -�-_- Number of pits.-. ----------Lining materials%.,( Size: Diameter- .-� ' --------Depth-- ... ?s ------------- esspool: Distance from nearest well---------------- Distance from foundation__----__----__----.Lining material_-_--_--_--_-_,------ -------------- El Size: Diameter-----=--• --------- --------- ------Depth------- --------- ---------- -------- - ---------.Liquid Capacity- -------- ---------- { " --------------------------gals. ♦. Privy: Distance from nearest well-__--_.-.__--------------------------------------Distance from nearest building ---------------------------------- ----------------------- ----------------, ----------------------- ❑ Distance to nearest lot line,--------------------------------- -- . , ,- ,- - _ -------------------------- Remodeling and/or repairing (describe):----------------- -- „ ..... . -- ------------- ------ .- _--------- ---•------------------- e144 __ -------------------:•-------•-----------•-------- ------------:--------------------.-----------------------•------•------------------------------ -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; ate laws, and ules and 'regulations of the San Joaquin Local Health District. "---- -- - -- --(Ow rand/or Contractor BY: (Title] --- - ------------------------------ ...Ts , (Plot plan, showing size of lot, location of sysfe in relation to wells, buildings,`etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----------------------------- DATE----- -- -- IEWED BY ---- - qu- - ------------ ----------- - -------- ---------- DATE------------�---- - ----------------------------------------------- UILDING PERMIT ISSUED ----- - --------------- ------ DATE---------------- ---- Alterations and/or recommendations:---_--. ....... --------- --------------------- -------- _en. ----•-- ---------- ,; - _ .-. � ------ r ------ ' ------- - --- - --------- FINAL INSPECTION BY:--_---- Date------/-o------ -.- - I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ '` 300 West Oak Street 132 Sycamore Street ' 814 North "G" Street Stockton, California ( Lodi, California Manteca, California I Tracy, California E5--9 145446 ATWOOD