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APPLICATION FOR SANITATION PERMIT Permit No. A'3'�e -2-- ------------------ (Complete in Duplicate) Date lssued'---yA/ 7' ry"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 L CAT19._ ----------- --?c5 07-------- ------ ........--------------------- ------------- ------------------------- Owner's Name--------------- --t-------W- - - ----- ----- ------------ ---------- ------------ - --------- ------------------------------ -- --- ----7- Phone -- Address---------------------- --------gP------ - - -- - --------- ------ ------- -- --------------- - -------- -------------------------------------------------------**----------------------------------------------------- ------------- Contractor's Name- C -------------- Phon Installation will serve: Residence Apartment House 0 Commercial [] Trailer Court [-] Motel ❑ Other ❑ Number of living units: -/--- Number of bedrooms -v-2-Number of baths ___f_ Lot size ------ Water Supply: Public system `Community system E] Private F-1 Depth to Water Table t� ft. Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam El Clay Loam E] Clay F] Adobe[�Iarclpan E]., Previous Application Made: Yes E] No EB-'-New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4Zt' Tank: Distance from nearest wefl------ ----------Distance from foundation------------------Material ,? No, of compartments------ --- ---------------Size.___________________.-_._------Liquid depth--------------------------Capacity----------------------- Disposal_Field: Distance from nearest well ---Distance from foundation-30." Distance to nearest lot line-------Zo-!- Number of lines------------ ---- Length of each line-----1?�F--------------*Width of trench------119y--11------------------ 4 ------------------- ---- ---- .4 Type of filter maferial-.!!�i-6V -Depth of filter material-----�/ Total length------------------ - ------------- Distance to nearest _____Distance foundation---- Distance to nearest lot line...IRA-!- Seepage Pit: Number of pits-------/------------Lining material__. ff 1<____Size: Diameter-----Z�. "------Depth--___n .S`--{--------------- Cesspool: Distance from nearest well-------- --------Distance from foundation--------------------Lining material-________-_-____._.._____________-- (" ❑ aterial----------------------------------- El Size: Diameter-- .------------------- -----------Depth--------------------- ---------- ----- -----------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------- --------------------Distance from nearest building_______--_.__.______________-__-.-____._. ❑ uilding------------------------------ ----------- F-1 Distance to nearest lot line--------------- ------ ------------ - ----------- - --- Remodeling and/or repairing (clescribe}:-.. ------ ------- -----------e�4� ........... ------ --------------------------------------------------------------------------------------------------------------------------- ---------------------- ------ ---------------------- --------------------------------------- -------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- -- ------- ---------- i � - - ------ -- -------------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa4av�s, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- ------------------------------- --— --------- ----- ------------------------------------------ -------------------I wner and/or Contractor) --------------------- By:------------------ - - ------------ ------ -----------------------{Title)----- -- -- -------------------------------- (Plot plan, showing location of system in rela�xellbuildings, tbe i to wells, ungs, ec.. can e paceon reverse side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- ---------------------------------------------------------- DA E............j--------- REVIEWED BY - -------------------------- ---------------------------- -------------------� DATE_-------------- ' BUILDING PERMIT ISSUED--------------------- DATE----- -----IS -------- --- N.- -------------------------------------------------- -------------------------- Alterations and/or recommendations:---- .... - ----------- ------ .. - --------------2----------------------- -----------------------------------------I ------- ----------- ------------------------------------I----------------------------------------------------------- ------------------------------------------- ---- ------ --- --- -- -- ----- ---------------- 6------------------------------------------------ ----------------------------- ------- ---------------------------------------------------------------------------- ---------------------------------- -------------------- ----------------- ----------------- -------------------------------- ------------------------------------ ------------------------------------ -------------------- FINAL INSPECTION BY:----------- ------------------------------- Date-------- - . 5-1--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfroot 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATWOOD