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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- �nA,,plica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. T application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND�PCATION.... #-", 4 � (�-------- ......... ----------------- Owner's Name-----___-. h Phone - -- ------------------------------------ Contractor's Name ------------------------ Address..............W__ ------- --------- _—------------------------------------------------------------- Phon ------- Installation will serve: Residence �'Aparfmenf House ❑ Commercial [:] Trailer Court 0 Motel [I Other El Number of living-units: _j---- Number of bedrooms ._-7-Number of baths __/__ Lot size ---- Wafer Supply; Public system RL„Community system 0 Private E] Depth to Water Table ---4--'ft.' Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E]. Clay E] Adobe Ek_Hardpan 0 Previous Application Made. Yes E] No �— New Construction: Yes 91—No El TYPE OF INSTALLATION AND-SPECIFICATIONS: (No .septic.tank or cesspool permitted if public sewer is available within 200 feet.) Septic k stance from nearest well__;___ ---- -----Distance from foundation---------------------Material El 1��N f compartments----- --------------- ----Size--------------------------------Liquid depth------------------------.-Capacity_•_-_-_-_-_-_-_-_-_-_-_---_- Disposa ----------------- Disposal Field: D;stance from nearest well-------------..--Distance from foundation--------------------Distance to nearest lo't line-_____,.________ ' ❑ ine------- --------- El Number of lines------------- -----Length of each line--------------------- --------Width of french-. Type of filter material--------- ---------------Depth of filter material------------_-------Total length_`------------------------------ i - Seepage Pit: Distance to nearest well__. ___.__ Qsstance Tf om found tif -------Distance to nearest lot line----JA------- Number of pifs�--- 9 /....Depfk... _�R,,57- ------------Linin ' meter........ A material--- do Cesspool: Distance from nearest well----------------Distance from foundation..- _.-------------Lining material-_.___-_._..___.________.______-____. ❑ Size: aterial-------------------------------------- Size: Diameter----' --------------------------------Depth-------------------- --------------------------.-Liquid Capacity-------- 41 gals. Privy: Distance from nearest well_________________________________._._.._---- .-Distance from 'nearest building__,___.._____-._________------------------ El Distance to nearest lot line_____.__.._ -- ------------------------- - _- I., P� --------------------------------•--------•-----------------`------------------------ -------------- "airg�d;_,scriib��-------- --------- Remodeling and/or repair�ng (clescribie):--------- -- -- ------------------ ------------ ----------------- - - ----- -------- --- - ----------- -------- --------------------------------------------------------------------- ---------------------------------I---------------------------------I..............-------- ----------------------------------------- ---------------------------------------------- ---------------------------------- ----------------------------------------------------------- ------------------------------------------------------------------------------------L---------------------------I_----------------------------- i-------------- I hereby certify that I have prepeired this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, and rules and regulations of the San Joaquin Local Health District. (Signed)- L--- ---------------------------------------------- --------------=-----.-----(Owner and/or Contractor) By: --------------------- (Plot plan, s owing size of lot, location�of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR ide)-FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------- ---- - --- ---- ------------------------------------------------- DATE - --------- it. 3--------------------------------------------- REVIEWEDBY------------------------- ------------------- ............ ------------------- --------------- DATE----- --- I------------------ ------------ DATE-------- ---------------------------*--------- BUILDING PERMIT ISSUED-------------- ------------------- ---------------------------------------------:__ - Alterations and/or recommendations:---------- ------ ------- ------ -••---------•_--------------- ... ...\S------------------------------- .. 7c---------------------------- ------------------------------------------------------------------------------------------------- --- ------- k------------------------------ ----------------------------------- ----------------------------------- ----------------------- -------------- ----------------- ft. ----------------------------------- ----- ----------------------------------- ----------- -- ---------- ---------------------------------- ----------------------------------------------------------------------- ------------------------------------------------ --------------–— ------------------- ---------------------------------------- ----------------------------------------------------------------------------- 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 Manteca, California Tracy, California 145446 ATWOOD