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'APPLICATION FOR SANITATION PERMIT Permit No. ___lQ__.!�--17__ (Complete in Duplicate) S� ` 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 mad_a in compliance with County Ordinance No. 5.49. T JOB ADDRESS AND O AT401. 4 �--.•-�-�-.��---�-- --�`L`'`-'------ =: ---'�----- ----- ----------------------------- ---------------- Owner's Name- ------- a �A�- Q Phone ° � Address --- 'a -----------------------------------------------------------7...... ---------.......1.' ' Contractor's Name. --- -,. e� --------------------------------------------------------------------------- --- Phone._ Installation will serve- Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.__-]__ Number of bedrooms _-c.�. Number of baths ._ _ Lot size ____T _ __ _._�__ 1 __________._ Water Supply: Public system ❑ Community system ElPrivate Ri"6epth to Wafter Table." ff. Character of soil to a depth of 3 feet: Sand _ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado e Er-'Hardpan ❑ Previous Application Made: Yes ❑ No 9K New Construction: Yes ❑ No ❑ �J TYPE OF INSTALLATION AND SPECIFICATIONS: g t r (No septic tank or cesspool per'rnitted if public sewer is available within 200 feet.) eptic Ta r Distance from nearest well__----------------Distance from foundation__-_________--- -.Material___-_____________-__.-_-__-_______-________-__. (� No. of compartments--------- .....Size--------------------------- ---Liquid depth------------------------`_Capacity--- d asal iAld Distance from nearest well-----------------Ws ' m foun ion--------------------Distance to nearest lot line----------------- u1 Number of lines----------------___-------------- ach line---- --------------------------Width of trench----------------------------------- 1n Type of filter material---------------.--------- ter mater' I----_____-___-_--.__-Total length_- __--------.______ %n Seepage ,Pit: Distance to nearest weIL1O ___________ stance"m �foun tion__. ___ Y O "J .�-i0____._..Distance to nearest lot Number of pits---- !---------------Lining .m �l_ ----- -Size: Diameter---?=3.f `-__-__-------- 1 Cesspool: D+stance from nearest well________________ m + ndat.ion_____:_-___- Lining material________________ ___________❑ Size: Diameter 3----------- -------- -- -------- p -------------------------- -------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___------------------------------------------ ---Distance from nearest building--------------I___________:______________- ❑ Distance to nearest lot line------ - ------------------ ------------------•------------------------------------------------------------------------------------------ S Remodelingand/or repairing (describe):-------- -----•---------- ----------- ---------------------------•--------•--------------------•-------------------------------•---------------------------------------------------------- "1 -----------------------------------------------------•--------=--------------------------------------•-------------------••--•-----------------------------••-------------•-----•------ i I hereby ert' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, aws, and rule d'regulations of San Joaquin' ocai Health District. - J !i°f'- _S �f-C/ -------- ---------------------- (Signed) ---- Contractor) g . ' (7�tle)- •-------- --- y.---_----------------------------------------------------------------- ---------------------- --------------=----- ------ ---- ------ ------------------ i (Plot plan, showing size of lot, location of system relation to wells, bui rags, etc., can be pl cel on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- - ------------ DATE---- ; � --------- - -------------------------- ---•-------- BUILDING PERMIT ISSUED ------ --------------•--••-•---------------- DATE---- REVIEWED BY- DATE Alter tions and/or_recommend do :____-- -- - ------ � (l'-�� -44;----••- I �---� ---- -- ----- _ .v,G qV{ •----•-------------------------------------- --------- :-------------------------------- --------------------- ------------------------------ FINAL INSPECTION BY.,._o� `�------------------•------------------• 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 9-21A 145446 ATWOOD 12-54