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APPLICATION FOR SANITATION PERMIT Permit No. ..-. -�_.-�--- v _ (Complete in Duplicate) Date Issued Vs(_ �^Applica+ion is 'hereby made to the San Joaquin Local Health District for a permit to construct and'insfall the work herein described. This application is made in compliance with County Ordinance No, 549, JOB-ADDRESS AND-LOCATION....4", Owner's Name------•6'_x"2#s... - -•- ----- - _ Phone Address.. -- --- Contractor's Name...---- -_I -s � a ...- 7 .: --------------- Phone. ---ep"," !_Q - - Installation will serve: f Residence AL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ._Number of baths'. __4�of size Water Supply: PublicR system ® Community system D Private Depth to Water Table Character of soil to a depth of 3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Cay Loam ❑ Clay ❑ AdobA Hardpan ❑ Previous Application Made: Yes ❑t- No [❑ New Construction: Yes R4_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:" - Distance from nearest well-----------------Distance from foundation--------------------Material_--..-...-_..._.._-.._--._--... ❑ o. of compartments------ -------------------Size--------------------------------Liquid•depth- Capacity . Disposal Field: Distance from nearest well---�__....Distance from foundation..---4Q!------Distance to nearest lot lin --,x- Number of lines.__--..._/.___- Length of each .line.........- 'ef %r" _i..Width of trench..-0-1 T e of filter material._.. . Depth �+------- --------- Yp oof filter material_---.�--�-__--..Total length__-.:.._.Seepage.Pit: Distance to nearest well__/ pi / .._-... stance fro foundation... i � �.�.-_.Distance to nearest lot line----- [ Number of pits_-_.. ...............Lining material `r , y ire: Diameter".,'` . ...._Depth �,�5:-- ---------•-- Cesspool: Distance fi''om 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 Cot line.............. =�- ,,. . -------------- ----------------- 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, Sf s, and rules and regulations of the San Joaquin focal Health District. (Signe ----- •--- -- -- ------- ------ Byc - •- --- ----- -- --` � --:=-----.--Title----- (Owner and/or Contract � n o or) (- ) �� - . - ---------------- of plan'. showing size of lot, locatiors of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY-----------=- --- _., DATE------ ------- ----- -- - IEWED BY ---------- ----- - -- - ---------------- --------------------------------- DATE--- BUILDING PERMIT ISSUED--- ---- -- fes` - DATE--------"- Alterations and/or recommendations:_..............._.._ -----•---- --------------- - --- -------- ®--- --------------------------------_--- ------------------------ ----- ---------------- FINAL INSPECTION BY: ---- --- ------- ----------- `--- Date---- ----- 1 b �So SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California c Lodi, California Manteca, California Tracy, California ES--9 145446 ATWOUD