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7 APPLICATION FOR SANITATION PERMIT Permit No. .../..s �. (Complete in Duplicate) Date Issued ___- `.. ._.. o 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 LOCATION_---------'-- -- ------14 ��r.�il Owner's Name---- 1. .l'1 '-�[�i- l t f�i*`_ "------- Phone--------------- Address---...•------ .. ----------------------------- 6_ --------- ----CContractor's ontractor's Name---------- —-------------------- ------------------------ ------------------- ------------------------------- Phone-----•--_------------ •------- Installation will serve: Residence 9Q.Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Ot,hfe-r ElNumber of living units: __ Number of bedrooms .� Number of baths ._ll----- Lot size -CI_--------- ------ -_____ Water Supply: Public system ❑ Community system ❑ Private 0, Depth to Water Table __�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoK New Construction: Yes V No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public�sewer is available within 200 feet.) — Sep is Tank: Distance from nearest well_�. Distanc fr foundaf;on-----�_a-------Material-------- °_ ,'_•! v_. No. of compartments------------- Size---- �-A__.5__Liquid depth__.___._._____--___.Capacity___ ------------- 1 Disposal Field: Distance from nearest well �4___Distance from foundation.__p._____-Distance to nearest lot line____6-_-__-___ I � l/ Number of lines__-._______________________.___. Length of each line_______I.. _.�'?_-�__.Width�of french....... / Type of filter material- ,__}�_CDepth of filter material---_----I-__._.__.Total length_____________ ________-;�.-- Seepage Pit: Distance to nearest.well___'________________Distance from foundation--------------------Distance to nearest lot line-----___:______ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------------------.----Dept h--.------------._- - --- -- t - Cesspool: Distance from nearest well-----------______Distance from foundation-------.............Lining material---- --- �� ❑ Size: Diameter------- ------Depth------------------ -------------------------------Liquid Capacity Y •` a .gals. Privy: Distance from nearest well._..______________________.____._.______...._Distance from nearest building._ .__`_-.F. -!-----------.-------.\ ❑ Distance to nearest lot line------------------------------------- �-yiL Remodeling and/or repairing (de/scribe .� ' 'F _ - ------------�+,� _! ! f� 1 ---------- ------ ---- -----------------------------------------------------• --------•---------------------------- -----------------•----•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State4aws, and rules and regulations of the San Joaquin Local Health District. �-�"-1�- * ___ f' _ _______(Owner and/or Contractor) (Signed) s --------- ------------------------------------ B je,l (Title]_ Y•----------------------------------------------------------------- ------------ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...-- -------------- --- ------------- ; DATE f -------------------- - - - - REVIEWED BY----- ---------------------------------------------------- ? t -I�-- -�: ° -------------------------- DATE_ BUILDING PERMIT ISSUED-------------------------------------- - -- --�- --- 11-------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations: - -------------------------------------------------------------- ----------------------------------•--------------------- I ---------------------- --------------------------------------- ---------------------------- ------- •-------...--------------------------------------•------•------------------------------- •---•----------- --••------••---------------------------- ----------------------------------------------------------- ------- --------•---------------------------------------------------------------------- ----------------------..------- ---------------------------------------- ------ --- ,f� __/� -� FINAL INSPECTION BY:. -- -----'� C__ ..._ 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 145446 ATWOOD