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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .-V- - ------- 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 compliance wi h County Ordinanc No. 549, JOB ADDRESS AND LOCATIO C; '_ _ C�-U._ -_S_7.� --------------�C� --- ---------------------------- --- ---------------------- Owner's -------------------- Owner s Name_.. ---------- < <�6cJ !.!l_ .. --- o- - ------ -------- ---------------------------- Phone._ fAddress--•---••--•---•-----....•-•-•�-----•----- -. �' `-'` �-`�' .1 s" f - ��-" -------------------------------- Contractor's Name ----------------� -,----------------"-••------------------------------------•-•--------- Phone----------------------------------- Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ �, Number of living units: ___-�- Number of bedrooms --;?— Number of baths -_/__ Lot size _.-_--_-%- '_/?' � too Water Supply: Public system ❑ Community system AT Private ❑ Depth to Water Table ________ ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan d p Previous Application Made: Yes ❑ No (K New Construction: Yes-0 No j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 206 feet.) — _- Septic Tank: Distance from nearest well__4.r:-----Distance from foundation_-.� _.-------Mat rial-__---_____.__"'t' _--_-" No. of compartment-s-------`� -..........Size-----=- _ ic�uia depth-----' --------------Capacity----- U-a Disposal Field: Distance from nearest �ll...`�___.._Distance from foundation__- d_.__..._Distance to nearest lone__--_.-�-.__ "# Number of lines_____,__--_---------------- Length of each line__________'-'_-.__--___-.Width of french_._._____"___-_�. . --------- Type of filter material-_- --------Depth of filter material--------/ ---------Total length________________---•----- .__- � ` 4 Seepage Pit: Distance to nearest well---------------_------Distance from foundation-------------------,Distance to nearest tot line__..__._____.__ _ ❑ Number of pits----------------------Lining material--------------------...-Size: Diameter-----------------------Depth.------------------------------- i Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material .____-...___..._.._-__--.___________-, ❑ Size: Diameter--------------------- - ........Dept h----------------------------------------- - ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________-------------- -----------__Distance from nearest building._.--___-..__.___._____ f ❑ Distance to nearest lot Iine------------------------------------------------------------------------------------------------------------------ -----------*--------------- Remodeling -------- *--------------- Remodeling and/or repairing (describe):-- ------ - ------ ------------------ -------•---•--------------------------------------------------------------•- ------------------------------------ ------------------- --------------------------------------------------------------------------------------------------------------------------------••-------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State la s, and ruEln egulati ns of the SV`Joaquin Local Health District. 5i nedP404vA/( g } --------------------------- {Owner and/or Contractor) - By------------------------ -----------------------------------------------------------------------------------------------------ITi+lel ---------------------------------------------------------- (Plot ---------•----------- -----------------------------------(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------ --- -- 7" - -- REVIEWED BY-- - -----: -- ------------ ----------------------------------------- DATE---- ----- ----••----------------------------------------------------- BUILDING PERMIT ISSUED-------•----------------------- --- ------------------------------------------------ DATE----------------•----- Alterations and/or recommendations-------------------------------------- ...... ------------------------•-------•------------ ----------------------------- ------------------------------------ -------------------------------•---------------- ---- 7--..-. --------- ------- --------------- ------ ----------------- ""...-----------------—-------------------------------- •------------------------------------ -- --.--= { -_-------------------------------------------------------------•--._-._...---I--------------------------------------•-------------------•-------•------•----_--------------------------•---------------------------------- FINAL INSPECTION BY: � '-x ;g ' 'n ---------------- ------------- Date.-------'--"---- ----- --------------------------------------------------------- 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 ES-9-2M 145446 ATWOOD 12-S4 +{