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APPLICATION FOR SANITATION PERMIT Permit Nor-_._.__to_._.... chi (Complete in Duplicate) Date Issued .__ Applica-lion 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 LOCA/TIIOfN_.p__�__r_ ___ ., ____-_. _ , . Owner's Name---------------------(.l�f-- �l f ----- ------------ Phone------------------------------------ Address.-•----------------------------- Contractor's Name---------------- --- ------- ---------------------- -------------------------------------------- Phone---------- ----------- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑. Motel ❑ Other Number of living units: ___.5Mik-4 o e rooms .-___. er of baths -------- Lot size .________ 7�_ _- -- -__--------__ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f]--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes El"'No ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation--------------------Material----------------------.------------------- ______- 1-1 No. of com artments--------------------------Size--------------------------------Liquid de th_-------------------------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 well----------------------Distance from foundation___________________ Distance tornearest lot line..--_--_--__-____ ❑ Number of pits----------------------Lini materia;-----------------------Size: Diameter----------------------Depth-------------- --------------• _ q !i Cesspool: Distance from Weare t w`eIT Distance from dation�_ .Lining materials-f___ -.__i1�_ Size: Diameter----- - ---��---------------Depth-----------� ---------------------------Liquid Ca aci Privy: Distance from nearest well- __-....._.___-____________________________Distance from nearest building.__-_________.______________.._____.__- ❑ Distance to nearest lot line-- - - ------------------ ----- ----------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ----- ---•-- ------- ----•------------------------------- -- __________________ _________________-----_-_ . S~F --------------------- --------------- ___ ___ _-.._______ __ ___ - - ___ _______.__• --` -.---- I hereby certify that I hav prepared this application and that a work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a {Signed] :..._.._ .-- --• -- ---- --------(Owner and/or Contractor) $y-- -------------------------------------------------------------------------------------------------•-••--- -----------------------(Title)--------------------------------------------- .! (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , i FOR DEPARTMENT USE ONLY 77 a APPLICATION ACCEPTED BY ---------------------------- DATE f REVIEWEDBY_ ---------------------------------------------------- - -- --------- DATE---------------- BUILDING PERMIT ISSUED-------=--------------------------------------------------------------------------------------------- DATE Alterationsand/or recommendations--------------- ----------------------------------------------------------•-------------------------------------------------------•-------•------------------- --------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------•---------------------•------------- ---------- --------------------------------------------------------------I------ ---------------------- --------------------------------------------------------------------------I-------------------!•------------------- FINAL INSPECTION BY:----- '" -------------------- 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 E3--9-21M 145446 ATWOOD 12-54