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APPLICATION FOR SANITATION PERMIT Permit No. .-. 0 -�__ __ (Complete in Duplicate) Date Issued.___yA1?1 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 NQ LOCATION.n_- ---------------- --- -----• - . Owners Name____:______ :_.. ___ . •--- -- ---- - Phone Address r . = �� = - 4 `'c��- Contractor's Name....&,V/ --------------------------------------------- --------------------- -- ------------------------------------=------------------._ Phone-------'----------------•--------- Installation will serve: Residence [/Apartment House E] Commercial ❑ Trailer Court [3Mote! ❑ Other E] j 1 _ Number of living units: ---- umber of,bedrooms Number of baths -_1___ Lot size __ ___- f ____ __ _ _ ______ Water Supply. Publics stem Communit system Private Depth to Water Table ________ ft. PP Y� Y Y Y ❑ ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gra-el ❑ Sandy Loam Clay Loam ❑ Clay ❑ .Adobe [Hardpan ❑ Previous'Application Made: Yes ❑ No [+� New Construction: Yes [J No ❑ t' TYPE OF, INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public se r is available within 200 feet)- ; Septic ank: Distance from nearest wel 414 Distancie fro foundation_!-�__- ._-_--_Mated_________________ ________.. I INo. of.}compartm'ents------ -- -- ---------- 5ize __x--`�l-- C- -,---Liquid depth---------.,-----...__._.__Capacity... -� Dispos l'Field: Distance from nearest well-.- .. Distance from foundation_A_�_f_.O_;_.__._..Distance to nearest lot Gne.r� '' [l� Number of lines---------- -------- Width of trench.-------A1__._____- �- -- --------Length of each fine--------�--�----Tf-- y------------ Type of filter materi6_l��" -K.D.epth of filter material____.___ -----_--Total length-__.____-.____-0--Q--------------- Seepa Pit: Distance to nearest well______________________Distance from foundation--_-_________..__:_.Distance to nearest lot line________________ S Number of pits.'__.':--- _-----�°_Lining material-----------------------Size: Diameter--`__ ''_�---Depth.......-------------------------- � Cesspool: I Distance fi-om nearest well-----------------Distance from foundation_._._.`.....--_---- Lining material----.._____.'._-__.___._____________ Size: Diameter---------------------------------------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals. 01 Privy: t Distance from nearest well----_----------- ~_ ___________________Distance from nearest building_.__-______-___-_____________._._.____._. - ❑ i _ Distance to nearest tot line--------- -------- - ---------- --------------------------------- ----------- ---------------------------------------------- Remodelingand/or repairing (describe):------------------------------------- ----------------------------------------------_----------- ----•---------------_---------------------------------- --------------------------------------------------------- I---------------------------------------------------------•--------------------------------------------------•-------------•---.....-..--•--------•---------------- `f ---------------------------------- -•---------------------- ------------------------------•-----------------------•-------------------------------------------------------------------------------- --------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate"laws, and rules and regulations of the San Joaquin Local Health District. G (Signed)----- I. -------------------- ------------------------------•----------------------------- -- (Owner and/or Contractor - By:-------`�`-"`�-` ---�"---�T---- -""'fit"--------- ------------------•------------------------- (Title} (Plot pian, showing She of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ----------------- -- ------------------------------------------------------------ DATIr ------ -------=------------------------- REVIEWED BY------ _ DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-----& ------------------------ -. --._ Alterationsand/or recommendafions:------ - ----- ----------- --- --- ------- ------------------------------------------------------•-------------------------•------------------------------ -------------------------------•-------------------...------------------ ------ ------------------ ------------------------------------ -- -------------------------------------------------------------------.... ----------I----------------------------------------------- ----------------- ------------------------- ---------------------------------------------------------------------•-------•-----------------------•--•------•----- --------------------------------------------------- --------- ------------------------- ---------------------------- ----------------------------------- -------- ----------------------------------------------------- _------------- ------ ------ ------------------------------------ FINAL -- -F]NAL INSPECTION BY:.-._/_..__�.� -----------------------------• Date----- -- ------------------ SAN ----------- •---- 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 ES-9-2M 145446 ATWOOD 12-54