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APPLICATION FOR SANITATION PERMIT Permit No. .__._ (Cornplete in Duplicate) Date Issued Jx�.l--•S lica�ion is hereby made to the San Joaquin Local Health Districtce 549r a permit to construct andel+�work herein described. AppThis application is made in compliance with County Ord Li . AT ___ ION •- I - JOB ADDRESS AND LOC ---•----- G° Phone-------------------- -------------- Owner's Name------------- _:• ------------•--------------•---------------------•------•---- , 40 4 'z- Address-----------------------• ' - l Phone---------------- •- Contractor s Name-----------! __---- -_-- Other artment House ❑ Commercial ❑ Trailer Court ❑ Mol ❑ ❑I Installation will serve: Residence p 1 --"-X� `-"_ Q ! Number of baths _f-____ tot size -- --- Number of living units: _"{---- Number of bedrooms Depth to Water Table _ "_ ft. Water Supply: Public' 171system Community system E] Private 10 Gravel Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: ❑ ew Construction: Yes No ❑ Previous Application Made: Yes ❑ Y TYPE OF INSTALLATION AND SPECIFICATIONS:- ' (No septic tank or cesspool permitted if public sewer is available within 200 feet �� — -----�� — - - --� istance fro found 'ion ----------------- ? �? ,. __ .� . �`, /K- �- q .Ca aci - Septic Tank: Distance from nearesr welly � `Q Liquid depth____--"�--- -- --- - P -----�-"" " - No. of compartments--- ------------r-- y ize .__ r 'stance from foundation_ Distance to nearest lot.line_ ---------- IleWidth of trench-_-.,.�------ - ------ Disposal Field: Distance from nearest we -- Length of each line-_______ -_Q-- -- ------- f Number of lines___.___ -- --=- g �� Type of filter material__ r Depth of filter materiaL___.Ag---------Total length:_____._f Q•U Distance to nearest well________ �-Distance from foundation__.__.__.__.____-_.Distance to nearest lot line----------------- Seepage Pit: -----------Size: Diameter-----------------------Depth-- -------------------------- 0 - - ❑ Number of pits---------------------- material_________--- ining material-- Cesspool: D•stance from nearest well------------- ---Di t}hce from foundation.. .-----.........Liquid Capacity_"_.--------------------____gals. ❑ Size: Diameter----------------- - p Privy: Distance from nearest well-----------------------------------"------------Distance from nearest building__ _. --.-- ---------------------------- Privy; ----- -- - ---- ❑ Distance to nearest lot ine_._".._-------_----- - Remodeling and/or repairing (describe)--------- ----------------- --` •-------:------------------- ---- ------------------------------------ ----- --- --------------------------------------------------------------- application and that the work will be-done in accordance with San Joaquin County I hereby certify that I have prepared this app' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ _(Owner and/or Contractor) ---------------------- -------- : Title ---------------- ---------- --------------- By:-------------------•------ -------- -ati - ---- ---:-in--- -----on -------- ----------- •(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:,-can be placed on reverse side). F DE RT ENT USONLY --_ DATE J� Z �. APPLICATION ACCEPTED B ---- -- -- - -- --------------'- DATE--------------- •-----•------- •---------------•--------- --- REVIEWED BY------------------------------------- ---------------- - DATE - BUILDWGPERMIT ISSUED----------- ----- ----------------- --------- ----------------------------------------•-------••------------- ---- Alterations and/or recommendations:--------------------------- --------------------------- --- ------------------------------------------ -- -------------------------------------- ------------------ _ Date..... �-- -- -;---�--- ------- ---------------------------- FINAL INSPECTION -- SAN JOAQUIN LOCAL HEALTH DISTRICT e14:North.."'-C"TStree+�W 300 West Oak Street 132 Sycamore S+ree+� - _ 130 South Americen'Street _ _ - - " }�anteea, Gelifomia Tracy, California -Stockton,-C6lifooyfua Lodi, California �M 145496 ATWOOD-Z 1Z-54