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APPLICATION FOR SANITATION PERMIT `` Permit No. __2_7_ "-- `~ (Complete in Duplicate) Date Issued ._ Applica4-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 comliance_w.ith County Ordinance No.`- 549. JOB ADDRESS AND pL CATION•lop r f _ - i _-.- ---� X01Aij�, I Owner's Name.__-- _ _-: ---- • -- ----- Phone-------- Address------- T, - ------- - --------- --------------------------- --------------I---------- Contractor's Name........ ...... i ---------------- Phone Installation will serve: Residence [R Apartment House ❑ Commercial El Trailer Cour# : ❑ Motel ❑ Other ❑ Number of living units: __r__-_ Number of bedrooms - !_ y Number of baths /__. Lot size -_-_-_ Water Supply: Public system ❑ Community system ❑ Nivate [jiL_ Depth to Water Table - {}- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa_m ❑ Clay ❑ Adobe 2, Hardpan ❑ Previous Application Made: Yes ❑ No j& New Construction: Yes No ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: I h:, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - 3.,. Septic Tank: Distance from nearest well-_7-of-_--_-Distance from foundation---_�'�f_•---.Material--�G--- _ _ - __ r }} No. of compartments-__---.- C- --------- - - �------Liquid depth.----f9d---- ------.Capacity Disposal Field: Distance from nearest well-- -Q..-_--__ Ar Distance from foundation--_,�-¢-_----_.Distance to nearest lot line_ Number of lines_____________f ._�`----__-- Length of each line---------�0�_-__-- _ _Width of trench-----.P:_!,F__�--- ---• ---_._ Type of filter material_ g _ --- Dept A of filter material---..--_--/j/ / h------ aeng �----------------- ^C Seepage Pit: Distance to nearest welt-.- ----DistanIce from foundatino ------Distance. to nearest lot line--. � N Number of pits--_- -._--_-_---__--Lining material _ ize: Diameter---- - -------Depth------�.��- I Cesspool: Distance from nearest well--------------- Distance from foundation-,---:- _-_---_.Lining material---------_----------- �~` t El Size: Diameter -------- -- -------Depth-------- als. -----------------------Liquid Capacity------------------- 9 Privy: Distance from nearest well.-_ -----_-- _--___1�------------------ -Distance from nearest buildin 9 --------------------------- ' ---- --Y ❑ Distance to nearest lot line ------------------------��_.•--_-----_-_ � Remodeling and/or repairing (describe)------------------ ------------------ _______- _,- --------------------- ------------ --------------------------- ----- --------•---------------•----- :i -----------•-----------------------•------------------------------------------------ ------------------ - - herebycertify that I have : - - - - - -----•----------------------- I Y prepared this application and Ithat the work will be done in accordance with San Joaquin County ordinances, State laws, and r s and regulations of the San Joaquin Local Health District. _ (Signed)------. - - !l -------( wOand/or Contractor) By: s �- •-------------- - -(Title)--�- (Plot plan, showing size of lot, location of system in relafion to i4 ells, buildings, etc., can be place- - on--- reverse side). FOR DEPARTMENT USE ONLY _ . APPLICATION ACCEPTED-BY--- ------ --- -------- - 11 ' DATE----- -__-- _ REVIEWED BY----- --•---- ------------ ------ ----- ------ - - - I�_-----------------------•---------------- � ---------- -------------------------- BUILDING ------- -------- ------- - DATE-- - UILDING PERMIT ISSUED. - --- DATE.. ---- •----------•-------•--------------------- --------------------------------- --------------------------- Alterations and/or ecommendafsons:-----------------L----„--__ 1 \ l -K--------------- -------------•` - - -'t-lt- ---•"-•---- c i� ff ----- - ----• ---------------- ------------------- -----------•--------------------------•---- Y - ------------------------------ - ------------------ . _ ----------------- FINAL INSPECTION BY:--_ .__ ---• - ------------ --------• ---------- Date-- � ---- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreot 300 West Oak Street I 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California Es-g 145446 ATWOOD