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` APPLICATION FOR SANITATION PERMIT Permit No. ------. ... �_ ...t (Complete in Duplicate) Date issued _A-Y"-2 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. JOB ADDRESS AN�Dj LOCATION n----�-`---�/.�-Q.�_�`:�-----,�A-Ner-__�.-.►. .T-hl�l.J�p-Gy-S--�-- ----- -- ----- ----- ---- Owner's Name.--•--1� � -rte ----------�` nPhone `sed Address-------------- .-------- -------------- ------------------•--.....------------------------------------- =---•-----------------------•---•------- Contractor's Name__., --`----- --- ------------------ --------- Phone. C7-� Installation will serve: I Residence 5�_Apartment House ❑ Commercial C] Trailer Court ❑ Motel L1Other ElNumber of living units: _`-- Number of bedrooms _lumber of baths// of size .--. --------------------- Water Supply: Public system ❑ Community"system ❑ Private JE�_ Depth to Water Table _6!;Pft. Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No F New Construction: Yes W 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--..11�-.--..--.Materia l ------------- , -------------- `rev J�� --Liquid depfih-----�tcf. -------..Capacity----- m No, of compartments- Size-_- ... t .-Distance from foundation----- to nearest lot Gne._� _-. 0D- . Disposal Field: Distance from nearest well_ Number of lines------v�--..- ---fir---------Length of each line--------, --.-.- -.Width of trench.----- - ---------------- Type of filter material__`L- 31- _!._,Rr_Depth of filter material--...f-g.--_-.-Total length-_-,.Jtrj --------------------- _ Seepage Pit: Distance to nearest Distance from foundation---- _-----Distance t9 nearest lot line_ice_----- \l Number of pits-------___---Lining material--.G-G Diafneter.-..- - --...Depth--. ! .0Z Cesspool: Distance from nearest well-----------------Distance from foundation----------.--------.Lining material------------------------------------- ❑ Size: Diameter-------------------=----- -------Depth---------------- ;---------- -----------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well---__--_---_---`--------------------------------Distance from' nearest building---------------------------------.--.----. ❑ Distance to nearest lot line-----------•-----------------------------------------•-----------:------------ -------------=------------------ ------------------------ Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------------------•-------------------•------•--•-------•---------------- .. t -----------------------------------------------------•-------------------------•------------------ -------------------------------- ---------------------------------------------------------- -------- -- I hereby certif ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws rules and regulations of the San Joaquin Local Health District. t -------- ----- F E --- (Signed)---- .----- �-- .(Owner and/or Contractor) orj ----[Title)---- -----------------------------sy:-_ � (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -------- ------------------------•---------------------------- DATE ------------ -------- -•-------------- APPLICATION ACCEPTED BY.. .-----'— ------------------ DATE--- - -------------------------------------------------- REVIEWED BY------------------- ------ --- - BUILDING PERMIT ISSUED-----` �, -----=----------=------------------- ------------------p----------------------- DATE.. -..r�-- --------------------------- Alterations and/or recommendations:-------------- ------------ -------------------------------------------- --------------------------------------•------------------------------- ---- .... -- -- F ------------ - -- ------ •- ------------ ------------------- ---•-- ---------`---------------TY ----------------•- -•----- •--- ------ ----------•------------•------------- ---- ----------- ------------- �., V FI NAL BY:... 'Date------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ik 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t Stockton, California Lodi, California Manteca, California Tracy, California ES--g 145446 ATWOOD