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y 1.r APPLICATION FOi,_ jANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- A __ . ---- -, 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. JOBADDRESS AND LOCATION--- _0 --- _2-A- -!.-d ------------------•------ ----------------•----------------•---•-• -----.-------------------------------------------- Owner's Name----M4.U_e.t -----------•---------------------- ------- - ------------------------------------- Address--------Xbs3_vg ----- -. -•-•-•. - -----,,rr--�--J-------- -------- --------- --------------------- Phone i '3 -- Contractor s Name------"' -------\_ _ T... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Wtel ❑ Other ❑ Number of living units: _-A... Number of bedrooms __Z Number of baths ---�___ Lot size ____ __ ._r �_1_-_-_-________________________ Water Supply: Public system [(Community system [I Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand'E] Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes E] No-ZZ/ New Construction: Yes [RI""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______-_--__-__.__.____________________.._---_. L 0 ;i ► 'Y Ck No. of compartments-------------------------Size-----•--------•-------- ------Liquid depth------------- ------------Capacity...-------------------- Disposal F' Id: Distance from nearest well.................Distance from foundation-----------.___.__.Distance to nearest lot line....------------- Al 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_ R.._.__.Distance to nearest lot une__S.______--. Ek-, Number of pits.__._--I--------------Lining material_N-l.----------Size: Diameter._30_____.__..___.Dept h Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-__----- ------------------------ --- ❑ Size. Diameter------------------- - ------Depth----------------------------------------------------Liquid Capacity------------------------ gals. Privy: Distance from nearest well----------------_--------------------------------Distance from nearest building_____--_---__.________._-.-_____._-__-___. ❑ Distance to nearest lot line--------- ------•-----------------------•--------- ------------------------------------------------------••---------------------- v} Remodeling and/or repairing )describe):_.- '`'� -- -- --------••------ l -----------------••-•----------••----------------•------- -------------------------------------••----- -------•---------------------------------------------••-----•---•-----------------------------------•-------------------....------------•------....-------•---- ----------------------------- -------------------------------------------------------------------------------•------------------------------------------•-------•--------------------------- ---------•--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----V -------------. -- ------- ----�----- -- -------(Owner and/or Contractor) y= - ----_... -�o �l.r.- ` --------------------------------------------------------------------(Title. --`--'---------------------------- (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)2 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- - -- -- ---- ---------------------------------------------------------• DATE------------ REVIEWEDBY--------------------------------------- - --- --------- .n-..,----------------------------- DATE----------- --•----------------- BUILDING PERMIT ISSUED------------- --------------- ----------------------------------------- --------------- DATE--.--------.- ------------- Alterations and/,or recommer#datio s•_____________ .__ . _ _ .----- - - -- ----- - -- a f ------------- —------------------------------------------------------------------------ --------------------------------------------------------- ---------------------- --------------------------------------------------------:-------------------- -----------------------------------------------------------------------------------------•------------------- _// FINAL INSPECTION BY:._-.__ _____._ A � ------------------------------- 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 E5-9J-2M 145446 ATWOOD 12.54