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ION FOR SANITATION PERMIT Permit No. ----- APPLICATII oca(Complete in Duplicate) Date Issued _____/G,!��---- Applica{ion is hereby made to the San Joaquin Ll Health District for a permit to construct and install the work herein described. This application is made in complia Fce with County Ordin nce No. 549. ----------------------------------- JOB ADDRESS A DLOCATI . _.___.`_--.----- -"- " Phone. ------------- Owners Name..-- -- --------- -------- - Q' ------------ ---------- -- Address.------- /J ----------- - ---- Phone---------------------------------- Contractor's 'Name-----------------•-------- ;-- -- -•----•--•----------•------------------------------- ------------------------ Installs+ion will serve: Residence Apa ent House ❑ Commercial Trailer Co rt ❑ Motel i❑ Other ❑ Number of living units: __ _._ Number of bedrooms'- .__ umber roof at `s ,tot size ----------_-! "" ------- Wafer Supply: Public system Cl' Community system ❑ Private ] Depth to er Table " --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I. Clay Loam.❑ Clay ❑ Adobe❑ Hardpan ❑ A Previous Application Made: Yes E] No)< - New Construction: Yes No ❑' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- `� 1�--.Materia-----------------f .------...---- - - ------- Septic,Tank: Distance from nearest well--.--- ----- Distance from/ f und7ation"___- -Capacity....... n�'--- No. of compartments-._-'-_.__. _ Size . 1- '= Liquid deP.t �. jp Disposal Field: - Distance from nearest weld_° c✓. --'Distance from foundation__ .__ ._v� _--•Distance to nearest lot line__.-"�. " If Width of trench----.- �/�----------------- Number of lines_i_:______� "" _Length of each line------- y-- n ' --------- ll Type of filter ma#enal__> � --Depth of filter'matenaL__.___...I .-..Total length__ - .C?----------- Seepage Pit: Distance to nearest well_'___ _______ ____Distance frorrr foundation___..--"_-___..___.Distance to nearest lot line----------------- I 9 c ❑ Number of pits--------------------:Lining material--------------------.1---,,ize: Diameter--------------------- - Depth------------------------------ Cesspool: Distance from nearest well----_-------------Distance from foundation- __----._..._.Lining material___._..__----_____.__--.____________ Size: Diameter----------------------------- ------Depth--- --- - -- Liqui ---- -- : ._._ ❑ _ ..,�� _ .x -. ---. .�.-r--.--R d Cap l� 4. _ �,� � w_ -.- _ �_ Ids ------------------------------------------ ------- --- -• Capacity Distance from nearest well: "..:_ Distance from nearest'bui •ng Privy: ----- ❑ Distance to nearest 4ot'line._' : . = ---------------- ------------------- -•--------------------•• ------------•------------- f i Remodeling and/or repairing (describe):_..."""__."-"____.__--..._______ _______________ -------------• --.------------------"-------------•--- - ----•--•---- ---------- 1 l y ------•-------------- -------------------• ;4 ---------•---•------ ' application and that the work will be done in accordance with San Joaquin County ! hereby-certify that } have prepared this- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . . � ---- - ---------- -----------------------------------------(Owner and/or Contractor) (Signs�d)-: rte ' ' J r ; " ------------------------- By:------ ...... ----------•------------------------------------ (Plot plan, showing size of lot, location of system in relatio to wells, 'dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ ------ ---------------- DATE----------------- ------- -- ---------- DATE----------- ---------DATE_".--------j ----------- REVIEWED BY ---------------- ---- -� - -----. DATE--- -------------'---•--------------------------- ------------ BUILDING PERMIT ISSUED-"--------------------- - t Alterations and/or recommendations:._.-_""_"..................................... "" 4 ---------- i1 =----------------- "_ .__. -- p t'-----•...__ --•--------------•----------------------- --------------------------- ------------ L ------------------ ---------- ------- ----------- Date FINAL INSPECTION BY:-----"�._--------- --- - - - ---------- ----- -�- - ---•-� SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y e5-9-2M 145446 ATWOOD 12-5n