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APPLICATION FOR SANITATION PERMIT Permit No. ..... ��. 1. (Complete in Duplicate) 3 Date Issued ..- / 1 �r8--c��t7•- n�- 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 compl- e with County Ordinance No. S49. JOB ADDRESS AND LOCAT 'zS°-- ---�---- '---------- "_ �- -------------��,--6--d. ,-ii----------` 4---1-4---------1A- Owner's Name--- -- ----•--V---'---------•-'-" ---------------------------- ----------- --------------------- Phone----------•-~-----•-------- Address------------------------------------------ - Contractor's Name--------- -------------------- y------------------ ----------------------------------- Phone------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: j--- Number of bedrooms _J____ Number of baths J Lot size -------�6- _ . • --------------- I Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table - it. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No N' New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_�v..__- Distance from foundation_.-'J ---------Material No. of compartments--------�- _..Size___ _�CXLiquid depth--------q_:._---------Capacity__.. ------- Dis os I Field: Distance from nearest well-_ ____Distance from foundation-----/G--------Distance to nearest lot line____.__' �; Number of lines------------Z----------------Length of each line-------- Q------------ -Width of french---------� _`�------------ '. Type of filter material_ ----_____.Depth of filter material----------j,?---------Total length------------------- _____________ p Seepage Pit: Distance to nearest well------------_---------Distance from foundation--------------------Distance to nearest lot line__.__._.___.__-.- °p ❑ Number of pits--------------------_Lining material-----------------------Size: Diameter-----------------...--_Depth-------------------------------- 9 Cesspool: Distance from nearest well--..-------------Distance from foundation--------------------Lining material__.___------- _______________-._._. ❑ Size: Diameter----- -------------------------------Depth---------------------------- -------------------•-Liquid Capacity_--------------------------gals. Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building--------------------------------._.____-_. ❑ Distance to nearest lot line---------------------------- - Remodeling and/or repairing (describe)---------- ---------------------------- ------------------------------•----------------------•-----••------------------------•---•------•----------------- ------•----------------------------------------------------•----•--------------------------------------•-----------------•-------------------•----------••---•-----------------•--------------------------------------•------- 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 sand �regulations of the San Joaquin Local Health District. (Signed) "---'-`---------------------------------------------------------------------------{Owner and/or Contractor) r BY-----------------------------------------.---------- ----------- ---------.------ --------------------------------------- ---.--(Title) ------------------------------------------ ------ 1 (Plot plan, showing size of lot, location of s-- - ystem in relation to wells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------------- --------------- -------------------------- DATE---------•------ .._ { REVIEWEDBY--------------------------- ------- --- -- - -- ----------------------------------------------------------- DATE-- •---•---•------ BUILDING PERMIT ISSUED---------------------- "-------------- --------------------------------------------------------------- ------------------------------------------------------------ DATE Alter- ions and/or recommendations:______. -._.__ - ------------ - ---------- ------ �. r �- A -- � ,� ------- h f..._.. ---- ----------- -- - . �" -------- ----- .---------------.--- ----------------- - ' ------ --------------- , ------- s •--•--------------- Date / ` FINAL INSPECTION BY:-- ..�1 �� 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---4---2M 145445 ATWOOD 12-34