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71 & GG APPLICATION FOR SANITATION PERMIT Permit No. ____ (Complete in Duplicate) / Date Issued --- r 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. /lel_� JOB ADDRESS AND LOCATION________ Owner's Name .--- - - ---- ��,� fZ� Phone----------------------- Address---------- - ----- ........... --------------------------- l --------------------------Contractor's � Phone ` - Installation will serve: Residence E5,Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other ❑ ,I jj Number of living units: _�____ Number of bedrooms _- .. Number of baths(------- Lot size ----�._n_------X__!-.e.�_____.._ Water Supply: Public system Community system ❑ Private'❑ Depth to Water Table ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,- Hardpan ❑ Previous Application Made: Yes ❑ No E5- New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ° (No septic tank or cesspool permitted if public sewer-is-available within 200 feet.) Septic Tank- istance from nearest well------.------_'.Distance from foundation__._---------- ------Material------------------------------------------------- E:1 _____________________ ______________________.❑ '` ,of compartments---------------------------Size------••-------------------------Liquid depth--------------------------Capacity-.-- Disposal Field: Distance from nearest well-________________Distance from foundation________:_.____..._.Distance to nearest lot line----------------- ❑ Number of lines--------------------------.---------Length of each line----------------- ----.-.Width of trench----------------------------------- Type of filter material-__._:_________________Depth of filter material---------------- -_-Total length__-___________.__________________---._._ Seepage Pit: . Distance to nearest wefl_./Y/? _-Distance f rpm foundation____ r�._-___Distance nearest lot line--,/"/____ Number of its- f_.__-_-_-_ Lining material__ ga-ei(eeDiam _eter___ Depth--1112 ' Cesspool: Distance from nearest well------------------Distance from foundation-----_-------------:Lining material--------------------------------------- Size: Diameter--------------------------------------De th------------------------- ----..-----Liquid Capacity_. gals. t Privy: Distance from nearest well------_--- -------------------�!------------Distance from nearest building---------_._-..____-_____ ❑ Distance to nearest lot'line---------.------------------- " Remodeling and/or repairing (describe]:--------------------------------- --- ------------------------•------------------ µ -••---------•---------------•---------------•-------- -------------•-------------------------•----•-------------•---------•-••-----•-------------------------•-• -------- ..............•......•-•-------------------------------------------------------------------- ---------------------------------------------•--------------••----- -•--•----------------------------------------------------------------------------------------------------------•----•----- -------------------------- - I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed}--- - r -------------------------------_----------:------------ {Owner and/or Contractor) --- --- (Title)--- By:- =' --------- ----------- --------------- (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 $Yw'a ----------- --r---------------------------------- --- DATE ----------- ---------------- '1� ----------- BY =------------------------- -------------------------------------- DATE-..------------------------------------------------------ BUlLDING PERMIT ISSUED _ --- - DATE =:S1 ._ : Alterations and/or recommendations: •- �---------------- -----------------------------------------------------••----- ••--- •--•--------------- ------- ----- ------------- ----- ----- --- ------ ` t --------------- FINAL INSPECTION BY:------ ----------'----------------_---- Date--- �----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD