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til APPLICATION FOR SANITATION PERMIT Permit No. ..... _ (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 Ordinance No. 549. --_�-. - JOB ADDRESS AND LOCATION______ --------------------------•---•- ,fir -_ - _ -• Owner's Name---- = �------ ---- ----- ---------------------- ---- - ------------------------------- Address -----------------------------Address p •---------- •-- -•-----------------------------------------------•--------•-----------------------'------•--•-•-------------------/---------•-------------------- Contractor's Name---- ---- � t✓ ` " � - •-• ---------------------------- ---------- ----------------------- ` -----..__ Phonol.. Cr Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_____ Number of bedrooms __ Number of baths _,f___ Lot size Water Supply: Public system CS Community system ❑ Private ❑ Depth to Water Table-�P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe; Hardpan ❑ Previous Application Made: Yes ❑ No [L New Construction: Yes;Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11 Septic Tank: Distance from nearest well-W- 47%4_'Distance from foundation____-J _i...... _--------_-----_ - _fir----__- No, of compartments-_-_-- .........----Size- - - ------Liquid depth--- ------------Capacity--- p -------- ' Disposal Field: Distance from nearest well_f-Vsifi.-C:9istance from foundation___o240-r.....Distance to nearest lot line Number of lines------------______ Length of each line_ _ _____; ___- Width of trench Type or filter matenal.__�_1___-_ �9.-Depth of filter material---- ..........Total length______ p_________________________ Seepage Pit: Distance to nearest well-. . _ Distance from foun4ation---45:2,:0._. _Distance +p nearest lot line___„hd__.- Number of pits_________________Lining material-- Diameter----R- _.___.Depth.- `------------ 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----------------------------------------- El Distance to nearest lot line---------------------- ----------------------------------------------•------------- Remodeling and/or repairing (describe):---------- ---------------------------------------------------------------------- --------------•------------------- ------- ------------------•-•------ Y ordinances, certifyate - , a d rules and regulations li the San Joaquin Local Health District.------------------------------ --ccor_ __ ------------------------------------------ I ______••_-___--__ -----______-_ n } herebycertify that I have prepared this application and that the work will be dans in accordance with San Joaquin County (Sig ------ ----- --- ---- --------- ----- �`� --------- -------------------------------------- --------Owner and/or Contractor BY: . •--- ------- --- --- ------ -------(Title)------1_ --=`'----------------- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ~ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- --- - ------ - - ---------------------------------------------------------- DATE------------------ REVIEWED BY � �� ------------------------------------------- -------- DATE----X''-'`' r- ... , ;-----•-------•--- BUILDING PERMIT ISSUED---------------------rZ---------t----------------------------------------------- ------------------ DATE.Z------- ----- Alterations and/or recommendations:--------------------- ------------------------•----------------------------------------------------•-------------------•----•---------------------------------- -•----------------------------------------------•--•-•••--------•----------•---•-- ------------------------•-------------------------------------------• ....._...__......------........._ ---•------------ ------------------------------------------------------------- ----------- ------ ------------------------------------------------------------------------------ ------------------------------------ - ------------------------------------------------------------------- -----•--------------------------------------------------------------------------•----------------•-•---- FINAL INSPECTION BY: ----------------- Date.....11 _2_7- -z------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street Stoek+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-9a r