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APPLICATION FOR SANITATION PERMIT Permit No. _--SKIV�_(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. i JOB ADDRESS AND LOCATION_.. f./ -__ __- ------ .--. Owner's Name" •- F _--------------------------------------------------------------------------- ------- -- Phone---------------- ---------------- t Address_. --- ------------------------------------------•------- -----------------------------------------•------------------- Contractor's --- ------------ .T tff r rr Contractor's Name.-- _ . -...-- --------------.... Phon{k_Q. 7.�-I_�--6,-_ Installation will serve: Residence ❑ ►Apartment House ❑ Commercialrai er Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths --- Lot size _.- ---4iG4,,at---------------_.---_-------__-- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 5&4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe 4—Herdim ❑ 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.) r" Septic Tank: Distance from nearest well_20.D.._Distance from foundation---/_�---___Material--------- -- ---- --- ------_ -_.--_-_--__. No. of compartments-------Z------------Size-il -X_ - -._--Liquid depth-__L �---------___Capacity 91 P Y--- '�__s----- Disposal Field: Distance from nearest well:g 6P...Distance from foundation____/_6_!---...Distance to nearest lot line---i--'••-_- ....� Number of lines---------/......_ Length of each line-------`._i3_-'-----------Width of trench__.`.="_--._-------___-_ Type of filter mat`eriaL_-�__�.._ -- ._Depth of filter material-----��_'�----Total length......tvB---A--------------------- Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot line___.----__----- , ❑ Number of pits---- ----------------Lining materia;....-------------------Size: Diameter-----------------------Depth-------------------------------- b 09 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------. 171 Size: Diameter------ -------------------------------Depth----------------------------- ----------------------Liquid Capacity_. gals. Privy: Distance from nearest well...........------------------- ----............._Distance from nearest building-------------_------ ❑ Distance to nearest lot line----------- --------------------------------------------------------------------------------------- c� Remodeling and/or repairing (describe): ----- ------------ . ..--•------•----•-•---•---------------------------------------- ----- - r -----------•-----•--------------------------------------------•- - I------ --------••-------------•--------------..........-----..------------------------------------------------------------------------------------------ V1 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate la s, and rules and regulations of the San Joaquin Local Health District. (Signed)--. ��-►e --------- Contractor) By:.-_--- ------- --------- --- - --- --- - (Title)----------------------------------- 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---------- -------------------- ------------------0$---------------------------------- DATE--------- REVIEWED BY- ------------------------------------------- ------ DATE------ -- BUILDING PERMIT ISSUED-------------------------------- -----------------------•------------------------------------------ DATE.--------- Alterations and/or recommendations--------- ---- •- - 1;4 G - -..---- r� ----`-�-- -------------------------------------------------------------------- -------------- ---------------------------------------- -........ --------------------------- FINAL INSPECTION BY:----------- --�----- - ------- Date--- - - ------ ---1 `5 --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT - ¢1 _ ... 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North-'-C" Street Stockton, California ) Lodi, California Manteca, California . Tracy, California E5-9-2M 145446 ATWOOD I2-54