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\ ' APPLICATION FOR SANITATION Cor PERMIT Permi No- -------- (Complete in Duplicafel /O Date Issued -----A/ Application is hereby made:to the San Joaquin Local Health District for a permit jo.construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - c-0 , L_ '. - 0 C-6 --, JOB ADDRESS AND LOCATION 7 / -CeJ -- -----------4jW.-4 "'.00 - -------- Owner's Name.----- ----_----------------------- --- Phone------- ---------------------- --------------------- Address-------- -- ---- 4 - I - -- ----------- - - - - -------------------------------------------------------------------------------- -------------------- ---------- Contractor's Name-----"__ (c, --- - -- --------- ------------- ------------------------------- ------------ Phone ---------------- Installation will serve: Residence Apartment House [Ij Commercra'_[ [-I Trailer Court [] Motel ❑ Ofher.,E] Number of living units: ----- Number of bedrooms --,-2—Number of baths -__1_- Lot size ------ Wafer Supply: Public.,system El Community system Ej Private ----------- I -Depth to Water Table (/00 ft. Character of soil to a depth!of 3 feet: Sand E] Gravel E] K� Sandy Loam [j. Clay,Loam E] Clay El Adobe Hardpan El Previous Application Made: -Yes 0 No El New Construction: Yes X_ No [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � . 4 •. " Septic Tank.: istance from nearest well_____-_----_-___Distance from foundation____------ .........Material of compartmenis.. ---------- Size-------- ---------- I ------------------------Liquid depth-- Disposal Field:❑ X. , -.! . . . / -------------- ---------Capacity-----------------1 4 Distance from nearest well./�v----Distance from foundafion__4_-3�.......Distance to nearest lot Length of each line------- Number of lines___.__-__ of trench____2 Type of filter material--- ,11�.......�-P,-Depth of filf6r material:,--.-/-.,. ... Total length------ ----Seepage ------------------------ Pit: .Distance nearest well----------------------Distance from foundation I —7------------ Distance to nearest lot line Ej Number of pits----------------------Lining material---------------------- sim:'Diameter-------------- --------Depth------ ----------------------•--- ' Cesspool: Distance from nearest well ------Distance from foundation.--,-.------------ Lining material____--_..---_----_______--__ ❑ Size: Diameter---------------------------- --------Depth------------- ------------------------- ---------------Liqdid Capacity----------------------------gals. Privy: Distance '.from nearest well-.-.- ------------ ❑ Distance to nearest lot line_______'. - - -------------------_-.-.-._..-Distance from'Anearesf building----------------------------------------- ----------------------------------------------------------------- --------------------------------------- Remodeling -----------------------------Remodeling and/or repairing {describe)________________. ------------------------------------------------------------------ ---------------------------------------------------------------------- ----------------------------------------------------------- -------------i---------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- t ----------------------------- ---------------------------------------------------------------------------------------------- ----------------------- --------- --------------------------------------------------------------------- - -----------------I--------------------------------------------- --------------------- ------------------------------------------------I-------- - ------------------------------------------------ I hereby erflfy.� h4ye prepared this application and that the work will 6e done in accordance with San Joay , Kuin Count ordinan,ce$ a t: laws. -d rules and regulations of the San Joaquin Local Health District. q (Signe ... ee ---- ---------- --- ------e,5.� A • ------ ------------- •--------- - --------(Owner and/or Contractor ----------------- - (Plot plan, showing size of lot,location of system in Z (Tif le):t... - -------------- relation forw.ells, buildings. etc., can be placed an reverse side). _j FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- -S ---- ------------ -----------------I--------------------------- DATE REVIEWEDBY i . -------- -------------------------------------------------- ---------------------------------------- DATE BUILDING PERMIT ISSUED--- ------------------------------ ---- ------ --------------------------------------------------- DATE. T'o N ACCEPTED D By G PERMIT ISSUED ------------------------- Alterations and/or recommendations___________________._. --- ------- --------- -- --------------- ------------------------------------------------ ---------- 11--------------- --------------------------------------_-----------------------------I ------------- --------------- ---------------------------------------------- ----------- ---------------- ------------------------------- _ --------------------_--------- ---------------------------------- -------------- ---------------------------------------------------------- .... ----------------- ------------------------------------------------------------------------------------ ---------------—---------- ----------------------- ------------- -------- ------- ------------------------ ----------------- -------------..------I-------------------- ....... --------------------------------------- --------------------�----------- -------------------------------------------------------------------------------------------- FINAL INSPECTION -------------I------------------------- Date-----La ---------------- ........ ----------------- ---------------------- 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 145446 ATWOoD