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t APPLICATION FOR SANITATION PERMIT Permit No, "! (Complete in Duplicate) �� Date Issued ---• f Applica+ion is hereby made to the San Joaquin Local Health District for permit to construct and install+10w n described This application is ma in compliance with my Ordinance No. 549. JOB ADDRESS AND OC ION---- -- ------- /[ ks�_ :nG -K�----_ - -- ---- •-....Owner's Name........... ------ - ----- t�F-(�t-�►'+.�'el _ Phon=y". Address--------------------- - - '------•. ••-- a...-- Contractor's Name...........XOL.aF ,------11—.r--� PhoneA OP44 ----- -------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑] Other ❑ Number of living units: .../--- Number of bedrooms __/___ umber of baths ____I__ Lot size Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ,A ft. Character of soil fc a depth of 3 feet: Sand C] Gravel F] Sandy Loam E] Clay Loam E] Clay❑ Adobe H/ardpan ❑ Previous Application Made: Yes❑ No LTJ' New Construction: Yes [sr` o TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ'c sewer is available within 200 feet.) Septic Tank: Distance from nearest wwe/�ell..74-----f-Distance from foundation_./jt_.........Material_____ -:___ ___ _ _________ _ No. of com artments__-/C.r------------. Size p - --- ,�`�„�.�.�i��_Liquid depth--,voyi� -------Capacity-900--- ,• Disposal Field: Distance from nearest well_ r-_„s.-Distance from oun a—ti on----�v.._.__.Distance to nearest lot line________________ Number of lines-------j_____`___ ___. __ Length of each line.... ... �_._.Width of trench-----.-_'S !�___________ Type of filter material__�_�1.___i9-_--Depth of filter material __-___Ag___-_-_Total length....46_Q........................... Seepage Pit: Distance to nearest well-------_------------__Distance from foundation....................Distance to nearest lot line---___________ t� ❑ Number of pits--------------- _Lining material____ _______________Size: Diameter-----_-----------------Depth--------------------------------- Cesspool: ____-____-__________Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 13- Size: _____-___ -.__---_.___ __-______Q._ Size: Diameter.-----------•------------_--------_Dept --- --------------------- --- ------__Liquid Capacity• --------•-------_----•--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------._-________________-_-__________- ❑ Distance to nearest lot line--------- -------------------•-------------•----------•---______------•--------------•----___- -•----•------•-•--------____--_--------•--- Remodeling and/or repairing (describe):--------------------- -------------------------------•--------------------------------------------------------•---•----•------------•-•---- --------------------•---------.--------------------------------------------•--•---------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------•-------------------•----------------------------------•-------------------------------------------•--------------------------------------- -------------------- -------------- ----------------- -----------------.................................----.........................................................................-------------------------=-------- Z 1 hereb certify t at I hay p epar&iaspplic ation and that the work will be done in accordance with San Joaquin Counordinances, a8 rule d rthe San J quin Local Health District.aA a ttt��►► {Signed) (4br Contractor) By..........................................................•--•••. •- lrtle) � ---------------------- u(Plot plan, showing size of lot, location of system in relation t wells, bildings, etc., an be plaEed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- _- -____._____-__._ ______ DATE ____ ______. t REVIEWED BY----------------------------------------------- --- DATE �l _--------------- BUILDING PERMIT ISSUED_---------_- -------- .............................................. DATE_---/- --- ------------------ --------............. Alterations and/or recommendations-------- -------------- ----------------- ----------------•-----•-•--•--•---------•-•-•-------------------•------•--•------•-----••------ -•------------••--•-••_----•-----------•-------------•••-._.-----•-•••- ------....----------------•---••------•-------•-----•------•-•---------------------•--------------------•-------------....----••---------------•- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------•--------_... ------------------- ------- ----•••. -------- ••------•------•---•------------ FINAL INSPECTION BY=------ ------ -----•-•-• ----------- ---- -- ------- - Date------ ---------6. --�'. ", - .......... 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 I• E5-9-2M 145446 ATWOOD 12-54