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r APPLICATION FOR SANITATION PERMIT Permit No. __.. -U--`' (Complete in Duplicate) Date Issued -..-.�?'71 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. , / 1� A 1_/V�-.�E,r--=------------•-------------------------------------- JOB ADDRESS AND LOCATION----- h--- -1------1-------- ----- - --- -._ __ . I �r ---------------- - -------------- Phone----------------------•--;-------- - , ------ Owner's Name--.._- __ - -- -- -- --------------------------------------------------------- r . l - ------- ----. --••-------------------------------------------------•------------ ---------- Address.. Contractor's Name-.----•.---�-.��I�""='�--"_=---•-�=`-------` ----r' -------------�-------•---- -- - -------•---•--•---- Phone_.�.::.�------•----�-° Installation will serve: Residence ER, Apartment House El Corn El Trailer Court El Motel [I Other L3 -Number of baths ---1__ Lot size -----r� ------e!----------------- " Number of living units: __!_._ Number of bedrooms __'��-- ------ ;� Water Supply: Public system ®_ Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @_ Hardpan ❑ .4 Previous Application Made: Yes ❑ No 9—New Construction: Yes ❑ No Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�a�nk: ' s�ance from nearest well_________________Distance from foundation-----._____.._.__.-Material---______---._-_-----------------.------.0-CZce compartments------- ------------------Size------- ---------------Liquid depth Capacity Disposal Field: Dist from nearest well..-.__---.------Distance from foundation__.-.---._-.-- --.Distance to nearest lot line----------------- f ❑ 'N4umberrof lines Length of each line-------------------------- ---Width of trench---------------------------------- Type fifilter material---- - -------- ---------Depth of filter material �7otal length -d - Distance nearest lot line-ra.----- Seepage Pit: Distance to nearest well---- d"�bDistance from foundation_-_.. ___.-- Depth / rze: _ - ------------ Number of pits-------1-------------Lining material- . ---------- Diameter------;--_-A---..- Cesspool: Distance from nearest well-----------------Distance from foundation-------___- ------.Lining material---_-.-.--- _-----_-.--.---_-_. ❑ Liquid Capacity . _ gals- Size: Diameter-- =---------- -------- --------- Depth-------------- ---------------- i --------------------------- . Distance from nearest-building ------------ Privy: Distance from nearest well----------------------------- - ❑ Distance to nearest lot line-----------------------------•- --------------- Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -------- ----------------------------------------------- t 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 regulations of the San Joaquin Local Health District. f ---------- ------------------------------------------ (Owner and/or Contractor) (Signed) ` - ----------_ - Title '= (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY DATE------ _ ----------------------- APPLICATION ACCEPTED BY---- ---------- ------ , ----- DATE----------------- !� `—----------- REVIEWEDBY------------------------------------ ------- "5 BUILDING PERMIT ISSUED--------------------------------------- DATE---------------- --------- Alterations and/or recommendations:.--._.-.- --------------------- ------- - E_ ------- - -------------- =4 � -- ------------- ---, f / - - ---- --------------------- ------------ ------------------------------------- -------------------- ------ ----- - -- •---- - Date- �-�----P- - - ------- ---------------------------------------- G�l -•-- - FINAL INSPECTION BY---------------------•- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton, California - Lodi, California Manteca, California y. ES-4-2M 145446 ATWOOD 12-54