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APPLICATION FOR SANITATION PERMIT Permit No. (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------- ------- ...... ------ - ------ G 6-_C�_/ S----- ----------------------------- ------ Owner's Name--------------------- Phone. r ` --------------_---- . ----------- -----•--•-----------------------•----- Address-------------------- r Contractor's Name T =- ----------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [j Other ❑ Number of living units: __�.__ Number of bedrooms .3. Number of baths ---/-- Lot size ---------------/--�C_ Water Supply: Public system Community system El Private E] Depth to Water Table -------- ft. Character of sail +o adepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam [I Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes"FgL_No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION ANDS"SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) t tic Tank4: / istance from nearest well -_____Distance from foundation _________________.Mater�aL--_-___-__.___._..__"____--____---_____.______. LSJ"1'� r" of compartments == Size--------------------------------Liquid depth------ -r Capacity--------- ----------- i osa Field: Distance from nearedwell __--Distance from foundation__--__?_P-------Distance to nearest lot line-----'S_-____ r Number of lines--------�---------------------Length of each line------------41-----4 ----.Width of trench.------ Type of filter material. V` ""AIIIA-:-Depth of filter material---- __":Total length______________ Seepage Pit: Distance to nearest well--------------------_Distance from foundation----------__.......Distance to nearest lot line ❑ g ' line_ --___--___-_____ - Size: Diameter------------------ --- Depth " YNumber of pits-------- =------------LLining material Distance from nearest well-----------------Distance from foundation.__--.----.__-_ -. Lining material__-.__--.___-_-____-_--_---__._____-. ❑ Size: Diameter Diamet:e_r.---�------a---------- ---------_--�--.------Depth------------------------------- - --- Liquid Capacity-. --- --•----- -- --• s 7 _-_-- __ ______- --- ----4 Privy: Distance from nearest wel H ❑ Distance to nearest lot line------- - ------------------------- a Remodeling and/or repairing (describe):---------------_---- - -- ------------------------.-••-•=--=-r---------------•-----------_...,•----------------------- ........ I - ----------- ---------------------• -------------------l ---•------------------------- --•------------ ------ ---------------------•---------------------------------••---------------------•-•-------....------•--------- ------------------------------------ ----------------- -------------------------------------------------------------------------------------------------•------------- 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 and regulations of the San Joaquin Local Health District.- > .•2: '`""` ----------------------------------------------------- -------------f-----------{Owner and/or Contractor) (Signed)--- (J--��`r__t -------•----- - ----------------------------------------------------- --- -�: Title ` B = (Plot plan, showing size of-lot, location of system in relation'-to wells, buildings, etc., can be placed on reverse side). s . ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------_----------- ------------ ---------------------------�------------ DATE -- - -------------------- REVIEWED BY------------------------ ------- -- ------ DATE.... ._� .r -- -- ------------------ ------- - ---------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------:= DATE-------------.-------------------------------- -------------- Alterations and/or recommendations------------ ---: -- ---------------------------------------------------------------•---•" --------•----------------- - = .- ---•----------—-------- --- � -----'� ------------------------------------------------------ -- rL�xi�G- ---------- - -a- -- -------- ---------------------- ------ ------. -•---- ----- ------ Date -- r _ n -.----- ------------------- FINAL INSPECTION BY:----- -------------------- 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--9-2M 145445 ATWOOD 12.54