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0�\,�i APPLICATION FOR SANITATION PERMIT Permit No. .... F--_ r : r (Complete in Duplicate) t 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. JOB ADDRESS AND LOCATION---- - --�------ �5-5--10-ru t1,4 d�---- - /u.V j -f-'" ��riU fG, Owner's Name---------6C/l1- /�yg'- cl '- C=t-f4 �' r Phone-- -- -_ _ � ----- Address-----•---------------- — ----- •--- •-----------------------•--•---•------------ --------------------•---------••------------ •---------------. Contractor's Name -------•---- `-------------- ----•----------------------------------------------- •------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ItMotel ❑ Other g L Number of living units:-------- Number of bedrooms -------- Number of-k�a#1is -_------ of size ------------------------%� _ __ivy ------- -Water Supply; Public system E& 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 a Hardpan ❑ Previous Application Made: Yes [❑ No 5g- New Construction: Yes a No ❑ � ` TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- _' Distance from foundation---A2--------Material---f CcJ4z y No. of compartments-------"7------- -----Size__;. _ f. - - -_Liquid depth---------y-------------Capacity----/Z_5___v-- Disposal Field: Distance from nearest well__.....""----Distance from foundation------la-__-_.-Distance to nearest lot line-----!S____1.---- 91 Number of lines------------3............. Length of each line------------ ---.--.Width of trench------- -/__�__.______.__- Type of filter material.-' 04*�_- .,Depth of filter material---------IR--------Total length-------------------- �d t ------------= Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_---_.---_---- ❑ Number of pits---- ----------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation___- ----------___.Lining material------------------------------------- El Size: Diameter----;f-------------------------------Depth--------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest we'll------------------------------------------------Distance from nearest building-.-------_---__---_-----_---_--.-.-__----. ❑ Distance to nearest lot line--------------------------------- -------------- --------------- ....-- ,. Remodeling and/or repairing (describe)=-------------------------------------------------------------------------------------------------.-..----------•----------------------------- ..-..._.-. --------•---•-------------•-------.-...----------•--------------------------------••-------------•-------------------------••--•-----•------ ------------------------------------ •---------------------------- s F . = ------------- I here6 r..ify that I have prepared this�application/Ad that the work will be done in accordance with San Joaquin County ordinances a`a laws, and rules a d egulatio'ns of.the Sin Joaquin Local Health District. l (Signed)- - --- ----- ----- --(Owner and/or Contractor) ------------ ---- , ------------OA_�;111� ----------------------------- - - .- By: r (Title) i ----- --- (Plot plan, showing size of lot, location of syst / n relation to wells, buildings, etc., can be on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------- � ------------- DATE------ f E" REVIEWED BY---------------•----------------------- ---- DATE - - - --------- --- BUILDING PERMIT ISSUED----------------- -- --------------------------------------------- DATE- - ---�------------------------ Alterations and/or recommendations------------------_--------- --------------------------------------------_-------------------------------------------- ---------------------•---------- -------------------------- --------------------"-- ---- ---y -. --- ----- -. --•----•--..---__-.--------------------.---•--•__-----' --" JJ ------- --------------------------------------------------------------------------------...----------------------------------- --- ----------- ---------------------------------------------------------------------------- FINAL INSPECTION BY:------- --------------- - C� _[`r6----------- ------ - ------------ •- - Date---/-� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California P ES-9-2M 145446 ATWOOD 12-ss 1