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APPLICATION FOR SANITATION PERMIT Permit No. _7Y ... (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 ---------------- -------------------------------------------------- ------------------------------------------------------------- -H_o__4��_�.-_ Owner's Name-------DY-.l'Yl-Oi. J T - ---------------------------- Phone._- Address _)- 1� �--------- ---------------------- Contractor's Name_-`---------------------------•---------- --------------••- -------------------------------- Phone----------------------------------- Installation will serve: Residence tX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j__._ Number of bedrooms __ie-. Number of baths _Q-_ Lot size ----- - -- -------- ---_---------------------------- Water Supply: Public systemCommunity system [I Private ❑ Depth to Water Table -------- ft. Character of soil to a depth otfeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 1W Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ 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 ________-__.__.__.-_.-.----______.____..____.__. ❑ No. of compartments--------------------- ----Size--------------------------------Liquid depth.-------------------------Capacity----------------------- Disposal Field: Distance from nearest well........ --------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines-- ------------ -----Length of each line---------------------------_.Width of french----------------------------------- Type OT filter material--------------- Depth of filter material--------.---- ---------Total length____-..___________._______.______.__.____ Seepage Pit: Distance to nearest well___-------------------Distance from foundation____-________...__•.Distance to nearest lot line._____--_________ ❑ Number of pits----------------------Lining material---------------------..Size: Diameter------------------._._.Depth-.---------- -------------------• . Cesspool: Distance from nearest 5ll__-_-_____._-;_-Distance from foundation---�0---------.Lining material--- ______________. ------- -- ----Depth------S---------------------------------------Liquid Capacity---------------------------gals. ` Size: Diameter..................... \ 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 and regulations of the San Joaquin Local Health District. Ss ned � {Owner and/or Contractor) ------------- 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 APPLICATION ACCEPTED BY -- - - -- --- - --- ----- ----- DATE-- -)!- _-- _ REVIEWEDBY------- ---------------- f - -------- ------------------------------------------1-------- DATE-- -----------. -----••- BUILDINGPERMIT ISSUED--------------------------- ------------------------ ------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:---------- ----------------------- --------•------------------------------------------------------------------------•------------......-----•-•- ----------•----------------•-----------------•----------------------------------------------------- ----------------------------------- ----------- S-1 3/^ ,_14) 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 Mantdca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54