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APPLICATION FOR SANITATION PERMIT Permit No. ___ff_`f_ -�___-• (Complete in Duplicate) • _ Date Issued Applica+ion 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 rO�rdinanc No. 549. JOB ADDRESS AND 'LOCATION. --------- - --- ---------- -- ---- ----- Owner's Name--------- _ Address-----------------------------------------------e i ---------- l Contractor's Name---------------•.__-- --•----- _ ----•-------------- ------------------------- ----- --- - -------- --- ----- --- ---•-- Phone / /f, Installation will serve: -Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L Number of bedrooms -A-.. Number of baths __I-- Lot size ---ld-�-fto ' Water Supply: Publics stem Communitysystem -----•--------------------- --•- pP y' Y i y ❑ Private ❑ Depth to Water Table ! 4_ ft. ' Character of soil to a depth of 3 fe#et: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 8-'Hardpan ❑ Previous Application Made: Yes ❑# No Q?"New Construction: Yes ❑ No [ J -- 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 from foundation-----/_ n Material- �--- --------�0_�� -------- �� No. of compartments-------�----------_----Size�_6 � J .� -- ' Liquid depth---lr4.Q. ---------Capacity...k isposal Field: Distance from nearest weft 24Ph PJ-Distance from foundation___Za-__.._.Distance to nearest lot line___.___. d-i Number of lines--------�------------------------Length of each line____�S -- - --V�/idth of trench. �' Y Type or filter material �2�- QC ` --�---- p of filter material--------��'-'�---Total length_---•---�-5�-!-------------------- Seepage Pit: Distance to nearest well-�----_Distance from fQundation____�S�� �. .-_.Distance to nearest lot lin_e__-/D ' Number of pits.----f_-----------Lining material-- -__- --�_-.Size: Diameter----33ii --_Depth-----v �S ! _ ` Cesspool: Distance from nearest well-----------------Distance from foundation.---_-_---___------.Lining❑ material Diameter-----I Liquid Capacit___.____.____._-_____._.__._______ l Y- -------------------------gals. V Privy: Distance from nearest well__________________________ --------- Distance from neares# building Distance to nearest lot line------------------- --- - - ___.--____.__---------•--- ------- ----------- ----- �. Remodeling and/or repairing (describe)__________________ -•---•-------•-----------•------- ---- { ----- - ----------•-----------------------------•----------------------•----•----------------------------------------------------------------••----------------------------- . ------ ----- ---- - ---- -• ------ ---- - ----- ----- - ----- -- -- - --- -- - --:-- •- • - -••--- - --- ----- T hereby certify that I neve prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, St to laws, and rules andlregulations of the San Joaquin Local Health District. (Signed)--------9--- ---------•----------- , I --- - caner end/or Contractor) By---------------------------------------------------------- -------� �.L�----lam/ {Title)--- _ (Plot plea, showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... ... ---------------------------------- DATE f ' ----------------- ------- -------------------- -------------------------•------ DATE BUILDING PERMIT ISSUED ° ----------------------------------- = Alterations and/or recommendations:--___________ DATE____._-_--____ F ---- -----•---------------------------------- ------------------------------------------------ - 42 FINAL INSPECTION BY:.. _------------- ------ Date------- - - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street :300 West Oak Street 132 Sycamore Street Stockton, California � 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD