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APPLICATION FOR SANITATION PERMIT Permit No. _-..�•�-��-_,�.. (Complete in Duplicate) '3 Da+e 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. C9 544. JOB ADDRESS D LOCATION-------- i --------------�'Q Owner's Name-._ 0..lt--- -- -- -�-- - --------------------------------------------------- ------------------ ----- Phone------------•--------------•-----•-- ----------- Address-----•- - — -------- ------------- - ---- ------ _ -----------e---------------------- Contractor's Name----- _ ------------------------- -- ------.._- Phone Installation will serve: Residence 24__Apirtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-_.- Number of bedrooms _J___ Number of baths ?------ Lot -------C ------------- ---------- Water Supply: Public system U..Gommunity system ❑ Private ❑ Depth to Water Table 6-a- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe fardpan ❑ Previous Application Made: Yes ❑ No g(.-,Iew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' ,a k Distance from nearest well-----------------Distance from foundation--------------------Material ---__.-----------.---.-----------_-------------. It No. of compartments------------- ------- ----Size—-----------------------------Liquid depth-------------- ------ ---Capacity----------------------- isposailF' Id: Distance from nearest weld------ ----------Distance from foundation-_.---.-----__.---.Distance to nearest lot line-----------...._- Number of lines------- ------------------=-------Length of each line---------------------------_Width of trench.-------------------------------•- Type of fi4ter material-------------------------Depth of filter material----------------__-----Total length---_---------------------------------- 11 Seepage Pit: Distance to nearest well�Distance from fo nciation--._/49_!___.Distance to nearest lot line--- ---_--- I Humber of pits-----_ Lining material--- -_ `_ -.Size: Diameter---02.. ........Depth----2_a!------------------- 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------------------------------------------ n 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)----ll -- -- ----------------------•------------------------------------------------��ontractorl -- ------- --- _ ------(Title)----------------------------------------------- ---------------- - -- - -------------------------- (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----------- - arr' ----------- REVIEWED BY------------------ -------------------------- ---- ----- --- . -- ------ --- _ DATE---------- ------------- -----------------------•-------- BUILDING PERMIT ISSUED---------------------------------- DATE Alterations and/or recommendations:---------- --- ----- - - ----------- ----------------------------•---------------------------------------------------------------------------•-------------- -------------------------------- r-�-� --�- tea.- -.>l6---- � ----------- FINAL INSPECTION BY------ ------- -- ---- Date------------------ ------`5 ------- -------------------------------- 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 E5-9-2M 145446 ATWOOD 12-54