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APPLICATION FOR SANITATION PERMIT Permit No. ._.L .--... (Complete in Duplicate) Date Issued __-cam�•----....._.� Applica4'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. 544. JOB ADDRESS AND LOCATION ad �� wGUI'---------------------- ----------------- -- Owner's Name----•---------•----•------------- = --------9A_ ,b? ------------+-- ---------------------------------------- . Phone------------------------------------- Address---------------------------------------------------------------------------t-------------------•---------------.................... ---_-_---------------------•--------•----••---------------------------- Contractor's Name-------------------------------------9�-fr- I+.E - e.-'----------------------------------------------------- Phone---j/0----�1ho.7? Installation will serve: Residence ❑ Apartment House ❑ Commercial W Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number-of baths -2.-- Lot size --------TS_. - �--------------------------- Wafer Supply: Public system Community sysfem ❑ Private ❑ Depth to Wafter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No4 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----A)_-_--.-..MateriaJ--------------w"----------------------------- - No, of compartments_.....`Z_._._'-___.-Size---6_1Y_q -----Liquid depth-------�}_'r----------Capacity------.S— ----- Disposal Field: Distance from nearest well-----�- Distance-from'foundation------1l-!!-...-..Distance to nearest lot line----S__-..--. ❑ Number of lines---------------3----------------Length of each line--- -Q.-LD__^3 f Width of trench-.--- -`r-_.---..-----.. Type of filter material------- Yowl._---Depth of filter material-__.-. --------Total length---- " Seepage Pit: . Distance to nearest well-------------_.------Distance from foundation--------------------Distance to nearest lot line----------------- FNumber of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth--------------------------------- {, Cesspool: Distance from nearest well-----------------Distance from foundation-- ---------------Lining material-.-------------------_-------------I— ❑ Size: Diameter------------------------- - ----- ----Depth----------------------------- ---------------------Liquid Capacity----------------------------gas. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.----------------------------- Q ❑ Distance to nearest'lof line--------------------------------------------------------------------------------------------------------------------- Remodelingand/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 regulafions of the San Joaquin Local Health District. i (Signed) ---.Owner and/or Contractor f --------------------- -----(Tifle)---- --------------------------- - -------------------------------- [Plo# plan, ;ho ing size of t, location o s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------------�� ------------------------------- DATE---------------= =J' --------- R1rVlEWEDBY - --------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations----------- --------------- -------------------------------------------•---•--••--•--•-•-•-------•--------•------------------------.... •----------------- ----------------------------------------------------•---------------- ------------------------- --------••-----------•.----- ------------------• ------------------------- ------------------- ------ -------------------------------------------- -- -- -------- ------------------------ ---------------------------------------------------- --------•-•---------------------------------------------------------------------------- --------I---•---------------------------------------------------------------------•---------------------------------------- 1 � S FINAL INSPECTION BY--- ---------------------�------- -- ----------------- Date--- - --•--- �---- r 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 145446 ATWOOD 12-54