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f �n 1 � APPLICATION FOR SANITATION PERMIT Permit No. ....... (Complete in Duplicate) "1 I is �v 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. This application is made in compliance with County Ordinance No. 549. ', - f - ------------------------------------•------------ JOB ADDRESS AND. LOCATION--�-------SU-v- -------- -��--------- ---- / --- '°�'n.�.�� Owner's Name L�---'�'---^�----•--- •----- Phone Address -----•---> •--------------------------------------------------------------------------------------------- Contractor's Name----i...All. tl=h�[-----•-• Phone Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _4___ Number of bedrooms __�_-- Number of baths _____�_ Lot size •____.�,�___X__��--------------------- r -- Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table _loft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g]_. Hardpan ❑ Previous Application Made: Yes ❑I No r� New Construction: Yes ❑ No 2�1_ ] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: c i�tance from nearest well-----------------Distance from foundation--------------------Material__________.___________..___:______..______.__. ❑ f compartments ------------------------Size--------------------------------Liquid depth---------- -- ---------.-Capacity----------------------- Disposal F-ei - ante from nearest well.................Distance from foundation-----_-_-_._..__....Distance to nearest lot line---__-___________ ❑ Nu r of lines-----------------------------------Length of each line----------------------------------Width of trench---.------------------------------- Type of filter material-------------------------Depth of filter mater-ial_. .-- - -----Total length------------------------------------------ Seepage Pit: Distance to nearest welL.__1� ;Os- —Diite from�f ind-a,tion______ _ �_._..___.Distanc�g to nearest to - Number of its.'_.---__ Zrial-�r_� Dia 'ter---- -- ----------Depth--.- -- --w c�-- Cesspool: Distance from 6earest weld----------------- istance from foundation--------------------Lining material__--_..-----_______.____.____________- ❑ Size: Diameter--' --------------- ------------------------ S --------Liquid Capacity----------------------------gals. '' > Privy: Distance from �earest well-------------------------------------------------Distance from nearest building------------------------------------------ G ElDistanceto nearest lot line-------- -t----- -- -------- --------------- -•-------------------•- ------------------------------------------- ------ ------------- Remodelingand/or repairing Idescribe):--------------------------------------------------------------------------------------------------------------------------------------------------•--•- I -------•------------- --------------------•------------•----------------------•-•------•------------------------------------------------------------------------------------------- I ------------•- ------•--------- ----- ----•- ------------ ----------------------------------------•------------ ---------------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County J` ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. 1 Si ned i` .----- --- -- ------ ------Owner and/or Contractor) ( 9 )••------ ------ SY: = oG ili1./ - - -------------------------------------------------(Title)------ --- -------=------------------------ ----------------- (Plot plan, showing size of lot, location of system in"relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED. BY ----------- ------- -------- -- ------------------••-------------------- DATE-------,-)-- --------------------------------- 0 REVIEWED BY---------------------------------- - ------ --------------------------------------.. DATE------------ ~-----------..------------------------ BUILDING PERMIT ISSUED------------ ----------- DATE-------•--- - ------------------------ Alterations and/or recommendations:._ -- ----- -- s ---- - --- --- ----------e--------- ------------------------------------------------------ --------------------------- -------------------------------- ----------------------- ---------------- ----------- ---------------------------------------------------------------------------------------- a.. FINAL INSPECTION BY:.---- ----------- 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 Es-9-2M 145486 ATWOOD 12-54