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r l � ; APPLICATION FOR SANITATION PERMIT Permit No. .._?. __z.�__ (Complete in Duplicate) Date Issued -- f ��J � -•------ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the work herein d cribed. This application is made in compliance with County Ordinance No. 549. �+� ' �� ^ � � 2� JOB ADDRESS AND L CATION ±--- - ----------------� �� L - ----------- - Owner's Name ------------------ - ---------------- -•----------------------- ---• -------- ---------•--------- Ph -- t-- ----------------- Address. ... H / i4%--- --------------{ .._ ` -•- - - --- ---- ---• -- Contractor's Name-_-____...______•___._. _ - • -------------------------- --------------------- - a----------------- Phone.----------•---- -----------•---- Installation will serve: ResidenceApartment House ❑ Commercial E] Trailer Court [-] Motel ❑ Other ElNumber of living units: _ Number of bedrooms -----/Number of baths -----(._ Lot size ._____ Water Supply. Public system ❑ Community system Private ❑ Depth to Water Table _—ko ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No b<-New Construction: Yes Ey No ❑ - TXP.E-OF—IN STALLATION-AND_SPECIFICA TIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - - Seotic flank: Distance from nearest well fir. istanc from f undo en__.____�� rr�� No. of compartments_ rze____ -- J - t . d x Liquid depth -- --------Ca acct 1 _=�._ p Capacity 8 � Disp al Field: Distance from nearest well. _ ..Q_C-__Distance from foundatio .__. �..7._____.Distance to nearest lot ling] ,�, --4. Number of lines___.__._...'_____________________Length of each line____-_ _ --�_-_-f�..__Width of trench._.__ I �* ----- ------------- Type of filter material._:S ]' pepth of filter material___----/_9* /"----Total length------------ -Q----------------I Seepage Pit: Distance fo nearest well-----__---------------Distance from foundation__..._____.--•:____.Distance to nearest lot line__-__.________-� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_._.-____-_--- ------ Cesspool: Distance from nearest well-------- -------Distance from foundation.__._.--------------Lining._ ,-�-�-❑-.•_ �-.�-�---_---—, _--�•_-.-..,..._.-.- __---rte. �-�-� •��-- - .,.�----- - - material-_._--.�.-Size: Diameter____ ------------------------------Depth -------------------------- ---Lr � .__________�_-___-_-_-_-_9___�--1�-� - ---- --- urapct ---�-----Privy: � Distance from nearest well-------- from nearest building ---------- ❑ Distance to nearest lot line-- ---------------- - --------------- ------------------------------ Remodeling and/or repairing (describe):------------------- I ------ ----------- ------------------ ------ - ------------------------------------•-------------------------------•-----------•----------------------------•-------•------------------------------------------------•------------ ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_... � ' _.._ _...� .. • --------------- - ------------------------------ (Owner and/or Contractor) YWI (Plot plan, showing size of laf, Iota ion of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------- ----•----------- DATE h - - ------------- REVIEWED BY-------------------------------- ------------ - --- ----------- -------------------------------- DATE --------------- BUILDING PERMIT ISSUED_________________________ ------ DATE----- ------------- Alterations and/or recommendations:___.__...__- ----••-------•------•--------------------------------------------- -------------------------------------- FINAL INSPECTION BY:_------------- f------- ----- Date......... SAN -- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT f30 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54