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APPLICATION FOR SANITATION PERMIT Permit No. .....Z_!_.. ..._.- (Complete in Duplicate) Date issued ------ 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.-;--- - - ---- -__-_-_------ *�- Owner's Name------- --- -----------••--••----•• -•---• •- - --------------------------•-----�...----•-- -- ----------------------------------------- Phone-.---------- Address �.... -'----------------------------- -- Contractor's Name. ------- ------•-------------- ---------- ------ Phone__ xe;__q xf---7 Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other [] f Number of living units: _ Number of bedrooms _,Number of baths A----- Lot size ---- Water --Water Supply: Public system Community system ❑ Private*Depth to Water Tablec.4.�Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Q§—. New Construction: Yes Q�,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Ta k: , Distance from nearest well_________________Distance from foundation----------------._Material------'---__.__-__-_ --------------.----------- El ____-___. � ❑ of compartments------- -- ---------------Size------•-------------------------Liquid depth------------ ---- --------Capacity---•-------- 1 Disposal Field: istance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------......... ❑ r of lines--- T ines :-------------------------------Length of each line-----------------------.-- ---.Width of trench----------------------- ---------- i Ty or filter material-------------------------Depth of filter material-----------------------Total length------------------------------------_--•-- i Seepage Pit: Distance to nearest wefl....N0lui..-Distance f om foundation__---_/Q___�__Distance to nearest lot line___,�F0__�-_ Number of pits-_ _"l._/______________Lining material- rt Diameter-_ --.�-�.Depth------- _t !�-------- - ¢ Cesspool: Distance from nearest well---------------__Distance from foundation--------------------Lining material_--.----------------._---__.__-_____. ❑ ' Size: Diameter----i.----------------- -- -----------------------Liquid Capacity---------------------------gals. . -------Depth--------- -- ------------- - l Privy: Distance from nearest well__-----------------------------------'____.____Distance from nearest building_.----------------------------------------- ----------------------------❑ Distance to nearest lot line.---- t • Remodeling and/or repairing (describe):----------------- - -------------------------------------------------------------•-•------•---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ••------------------------ ---------------------••---•------------...---•------------------••---- -------------------•••----------------.-------------------------------------------------------------------•------•---•---------------------------- _ _ E ----------------------- -------------------------------------------------- ---------------•---•-----------•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat and rules and regulations of the San Joaquin Local Health District. (S�9n =� ---- ------ - - --------------- -------------------------•----- erand/or Contractor] BY: -•- •--_ ----- • = (Title)--- �. .(Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - 1 APPLICATION ACCEPTED BY- --------------- -------------------- + REVIEWED BY----------------- DATE- ! BUILDING PERMIT ISSUED r---------------------------------------•--•-•----------------•---------------------._ DATE------- -- ---- Alterations and/or recommendatio s---------------- ------------- ----------- -----------------------------------------------•----•---------------------•-- �- ----------- --- -E--.... . --------•=••--------------------------------- FINAL- INSPECTION BY:............ ---- - —Date....... I � M SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E s-9 149446 ATWOOD