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1�1Sy � p {b / APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica+ion h 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 L ATION---------- "aZ �� "" A � ^ ---------- •------------------------------- ------------------------•-- Owner's Name- J - _ _ Phone, Address___ - �1,�9.Qi•"-� "• Contractor's Name _ --------------- Phone_ Installation will serve: Residence © 'partment House ❑ Commercial ❑ Trailer Court ❑ Mofie! ❑ Other ❑ Number of living units: _/_._ Number of bedrooms _9j- Number of baths _/_.- Lot size ___!_ ^�/�/�S�D Water Supply: Public system 2__�Community system ❑ Private ❑ Depth to Water Table ft.ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: Yes [] No �ew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well_,.__ Distance from foundation-,..14--------Maferial__!9�'"__-.�9" v No. of compartments.-.------c2.------_--.Size__S _ ! ----Liquid depth------ -13__.---------Capacityd Disposal Field: Distance from nearest well_24il"'-0V Distance from foundation.._ _`_/� .0 C!_.___....Dlstance to nearest lot fine------- .... . Number of lines___"_____/._---.. Length of each line.......... -------------Width of trench--___� f ------------- Type of filter materials-, ._._-_Depth of filter material___-_-e-`"-----Total length_-____3�_"--� �y, --------------------- See^pag'e Pit.: Distance to nearest well.'2— "--_Distance fro foundafiion_�d_-----" pis#ante #o nearest lot line__-_�d__.� La' Number of pits-------/-----------Lining material St_i".. - Diameter----3 .- ----Depth___-_. r__--------"-_ Cesspool: Distance from nearest well _ Distance from foundation____________________Lining material__.-__._-""-"- ------------------ --- ❑ Size: Diameter Depth_. ------- ------ - - - ------Liquid Capacity ----------------------9(31s. Privy: Distance from nearest well..------------------------------------------- --Distance from nearest building__._-.."-------------------------------- Q El 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -"••-- , ------- _. _- _[O er and/or Contractor' ----------------- By- ) - _�_ `--------------•------------ Title)__ (Plot plan. showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- -------------- ----------- DATE.._-_ _ r REVIEWED BY - •--------------------- DATE-- BUILDING PERMIT ISSUED--... -- DATE Alterations and/or recommendations:.._-__`--------- ___---' ---------------------------------------------'--------- ----------"-----•---------- ------------------- ------------------------ ------------------ 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 E 5-9 145446 ATWOOD