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APPLICATION FOR SANITATION PERMIT Permit No. .___—F--- . i (Complete in Duplicate) Date Issued Applica ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4jgf s application is made in compliance with County Ordinance No. 549, II f•f i9-,�-,�cSo� .S7- - /✓/V-,DDRESS AND OCATION `' -------e----- --------- ---- ---- ` J 1 Owner's Name.--109(41Y-- �/ �� :Q./ _-. ' ' Phone i Address--------------- Contractor's Name-------- ..:_.c� LAau _ _ �- -•p ------�--- -- ❑' --'--'-- ---- - ------'❑---Trailer Court ❑------------------------------------------------------ Phone ❑ ---Other--❑----------------y � Installation will serve: Residence Apartment House Commercial j Number of living units: 2'__ Number of bedrooms .�_ Number of baths _/___ Lot size ___Z�-G7.___X___LC1__ Water Supply: Public system 0_ Community system ❑ Private ❑ Depth to Water Table _ ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RL Hardpan ❑ , Previous Application Made: Yes ❑ No �9_ New Construction: Yes JC No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-'A/Z?'6+eD1stance from foundation_._.d..........Material--------6-----G- �-�r� ' K . No. of compartments._.--z_-?-----------.._Size--- ---Liquid depth-__.1~4...I.___...Capacity-------9om)--- Disposal Field: Distance from nearest well__f!��stance from foundation--- -- .......Distance to nearest lot Number of lines-------- r trench-_ ,52. of each line_________ -__.._____.-.Width of trench_ r52. __�.�----_---_- Type of filter material----4g-._�SXDepth of filter material----/-9.-/--'---Total length-------- ____________________ Seepage Pit: D � —istance to nearesf well_ ._/�G:}��__Distance from foundation_._,�__�___.Dis ance tof � nearest jot line--- j yy Number of pits----- ____.__-_ ___ _. -.Lining materia;---- Diameter_____ _-_A . Depth_---_ �--------_ Cesspool:. Distance from nearest well-----------------Distance from foundation._ _____-.._.__..__.Lining material-------------------- LA ❑ Size: Diameter-------- --------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. i I Privy: Distance from nearest well------_...__------------___---------------------Distance from nearest building___---______.-__________-_--_--------- ; ❑ Distance to nearest jot line-------------------------------------------' p I , 1 I , Remodeling and/or repairing (describe)--------- --'-- -'------------------'----•------=------------•----•---------•------------'---•------------------------------------------- -------•� _ -----------------••----•--------------•-----•-------------------=---- ---------- --------------•--------••-----------------•---•----•--------•--j-------•-----------•----- -------------------------•----=-------------.._..----------------------- --------------- --- -_-- --------- - ----------' ' --------- --•---------•------------------°•------------------ ----------•------------ ! I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County iordinances, State s, and rules and¢regulations of the San Joaquin Local Health District. y ---T-- - - -- - -'- -'--( --- (Signed). ------------------------ --- -----------(Owneand/or Contractor)--: - ��-- ---' -- -----------------------------------------(Title ------- '------------------------------- I a - i (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 I APPLICATION ACCEPTED BY--- ------------- -- ----- ---- --- ----------------------•-------------- -----------•--- DATE,--- REVIEWED ATE.--REVIEWED BY---------------------------------------------- ------ DATE--------- -- BUILDING PERMIT ISSUED------------------ --- ------- - -- --------------------------------------- = DATE-.- ' -• -------------------- Alterations I and/or recommendations:.----- ---------- 4-1 i -----' - ----- --------------------------------- -- ��-------------------------------------- ---------- --------------------------------- -- --- --- ------ -- ------ ........4 ---• ------------- -------------- --------- -----------------•- ------ ---------------------------- ------------------'------------------------------------------------------ -------------------------- --------- FINAL INSPECTION BY: -- Date - "� _• = ------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD I '