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APPLICATION FOR SANITATION PERMIT Permit No. -------- -----3---- (Complete in Duplicate) � ?// ja Date Issued _________________s__ 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 AND LOCATION___ -f----------- --- Owner's Name---C_-/-------l __-®'S'S------------- - --- Phone--------------------------------- Address ------------------------------------•---------------------------------•-- R's _,. Contractors Name----- .__ 1h. ------- � -`-•------------ - Phone - Installation will serve: Residence [[I/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/_ Number of bedrooms _--.-7-Number of baths _L.-- Lot size ---- -d__� ________________________ Water Supply: Public system ®/Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[tea dean ❑ Previous Application Made: Yes ❑ No [9--11'ew Construction: Yes ❑ No E4-,- V 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----------------- from foundation------------ Material------------------------------------------------- ❑r�'►. I07 No. of compartments----------- --------------Size--------------------------------Liquid depth---------------- .........Capacity--•-------------------- Disposal Field% Distance from nearest well.................Distance from foundation------------------..Distance, to nearest lot line----------------- ❑F'.41I hfr 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_A4_64.L.___Distance,fwm foundation-___ __f___-.Distance to nearest lot line-. [ Number of pits___.._.l____------Lining material--- �. -Size: Diameter____ _ _________Depth------ y_-._____._________ 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.--..-w ��-�i / ! Remodeling and/or repairing (describe):--------- �1�►� ' � ----•----"---"------------------------------------ ----------------------------------•-----------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------- ------------------------------------ --------•-------•------------------------•---------------------------------------------------------------------------------------- -----------••---------------------------------------- I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. p p r(Signed)-------- A-!_S_ A- --------- -------------- ------------------------------------------------=-------- - - ner and/or Contractor) BY� -- ------ = ---------------------------------- --------------------------------------- (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 APPLICATION ACCEPTED BY DATE ----------- ---- ----------------------------- REVIEWEDBY-------------------------------------------------- ---- ------------------------------------------------------------------- DATE-------- ------•------------------------------ BUILDING PERMIT ISSUED------- ----•-------------------- ------------------•-------------------------------------- DATE.. --------- -vJ Alterations and/or recommendations:.-------------_------ ___ __ __ -•-----------------------•-------- —---- rte +� ------- Y• ,--------- -------------------------------------------------- ---- (•-r--C�`C, -------------------------_-- ----------------------------------------------------- -----------------------------------------V1 -•---•-------:------------------------------------------------- t------------------------ ------------------------------•-----------------------•----------•---•---- -------------------------------------------- --------- -----•-••------------ FINAL INSPECTION BY:-----Fre_'Q_ ---------------------------- Date- ---- -- �]-!-J ` SAN JOAQUIN LOCAL HEALTH DISTRICT 6 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES___9 145446 ATWOOD