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ov-�q tlll� APPLICATION FOR SANITATION PERMITPermit No. (Complete in Duplicate) Date Issued --- a Zolo 0 led a*ro P 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 LOC -----...K.....-----..49a_6�----I-------- 0 ION- '60 44 ..... ---- -5 Owner's --- ---------------- --------------- ------ Phone------------- - ----_------------- ;i2- - Address----------- ------- -----V - ----------------------------------------------------------------------- ------ ---------------------- --- --------- 4 -- --- W-61 Contractor's Name----- -------- Phone, Installation will serve: Residence 71—Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other [ Number of living units: Number of bedrooms _,j_—Number of baths ./----- Lot size ----- -------- ---------------- Water Supply: Public system [I Community system El Private 0-, Depth to Wafer Table,�;_W. ff. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay E] Adob;�Hardpan L] Previous Application Made: Yes [I No 0— New Construction- Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspodl permitted if public sewer is available within-200 feet.) Septic Tank: Distance from nearest well--.-A,�---Distance from foundation--. ------material--- ----- ------ JZL No, of compartmenis....._2-- ----------Size--- -----Liquid depth.... .K',O-----_-------Capacity.Azry------------ Disposal Field: Distance from nearest well- Distance from foundation---- :-/-.Distance to nearest lot line--. .Q-f-_. Number ine--- Number of lines---------j........ ---------Length of each line----/OVI1------------Width of french---•�_41-------------------- Type of filter material--/ oe p jj------ Depth of filter material....--1-g.-__ ----Total length---.. ------------------- Seepage Pit: Distance to nearest well...----..-------.-----Distance from foundation--------------------Distance to nearest lot line--.-------------- [--❑ .I Number of-pits---------------------Lining material--•--------------------Size: Diameter--- --------- - -----.Depth------ -------------------------- Cesspool: D+sfance from nearest well-----------------Distance from foundation-----..............Lining material---.__.----.----..-.----._-------_--_ �# ❑ aterial------------------------------------- El Size; Diameter---- -------------------------------Depth----•-----------•---- •---------------------------Liquid Capacity----------------------------ga S. Privy: Distance from nearest well-------------------------------_--.-_ -----_----Distance from nearest building----------------------------------------- ElDistance to nearest lot ---------------------------------- ----------------•--:.....---------------------------------------------------- ------------------ and/or repairing (clescril?e):----------------------------------------------------........_----------------------------------•-------------------------------------------------....... -----------_--_---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------i�-----------------------------------------------------------I-------------------------------------------------------------------------------------------- --- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 's ordinancesi , State , and rules and regulations of'the San Joaquin Local Health District. ' � ---------------(Owner and/or Contractor) ---------- --------- ---- -- ------------- (Signed) --------- ----------------------------------------- ------------------(Title)_ --- ---------------------------------------- ....... .... By:-•- ------------- _ --- ---- --- (Plot plan, showing size of lot, location of sys�em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------•------- :..- ---- ---------------------- DATE----------- ------------------ REVIEWEDBY-------------------------------------I——- ---- --- ---------------------- --- --------------------------------- DATE------------------------------------------------------- BUILDING PERMIT ISSUED------------- ------- ---- ----- DATE------------ ................ -- ---------------------- -------------- . ...... ----------- ----------- Alterations and/or recommendation,,,- ... ----- -- --------- -- - - - -------- -- ---------.. ------ ---- -------------------- ----------------------------- ------ -------- ----------- ----------------------------------------------------------------------------------- ------------------------------------------------1---- ------- ---------------------------------------------------------------------- -------•-'---.....-- ---------------------------------------------------- --------------------------------------------------- -•--... - ----- -------------------------------------------------------------- --------------------------------------- ......... - _ FINALINSPECTION BY----- - -------- --------------------- ------------------ ------------------------------------ SAN J AQUIN 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 149446 ATWOOD