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Q0 W APPLICATION FOR SANITATION PERMIT Permit No-5-Is-Is _Z_ o (Complete in Duplicate) �1 • Date Issued --- -�-9-AZ , 2-(2- 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. �j� ---- `,`�... JOB ADDRESS AND LOCAT N.____-- -- - ------ .- • -- ' ------------------------------------- Phone------------------------------------ -------Name------- ----�-----•-- --- -•-• -- - ---- ---- -- -------------------r------------- -- -- - ---------------------------------------•----------------------------• --------• Address----_----- --- -- Contractor's Name------------- • - -- ------•-- ------ Installation will'serve: Residence EErApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i i Number of living units: _�.-_ Number of bedrooms _02- Number of baths -_�_- - Lot size _--------- Water Supply: Public system 0----co system ❑ Private ❑ Depth'to Water Table . � ft_ ,❑ f Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam ❑ Clay"Loam [I Clay ❑ Adobe[ale pan Previous Application Made: Yes ❑ No U?--'-New Construction: Yes B—No 1.1 .' k TYPE OF INSTALLATION AND SPECIFICATIONS: : (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ----------- Septic Mat rials -------------------- Distance - `"�---' Septic Tank: Distance from nearest wel€ '��Distance from foundation-- -_ - d� f �d --._capacity ---------------Size`r� � ---Liquid depth------- -- p Y L'S No. of compartments--_ ------ Disposal Field: Distance from nearest well Distance from foundation--/11__..._----Distance to nearest lot line ----------- Number of lines--------- _._--- Length of each line-- S�_--.-__.�Z--.Width of trench Number of filter material s, -Depth of filter material--.-_,/ --------Total length.--------_5--�------------�.------ W ... Distance from fo dation-_.-_w._-.--.Dista ice to nearest lot line---'5-----_-_-- Seepage Pit: Dis#ante to nearest well_ - Size: Diameter_..- -------------Depth-----r�--- v) Number of pits.-..____�-----___---Lining material._�- . Cesspool: Distance from nearest well---------------.'_Distance from foundation------------.-------Lining material ------------------------------ ❑ Size: Diameter------------------- ------------------Depth---•----------------------- ------ - ---------Liquid Capacity------------------------- -gals. Privy: Distance from nearest well--------------------------------- --- ---------.-Distance from nearest building-----------------------------_: ------ Privy: ;4 .- 4 ❑ Distance to nearest lo# line_---------------_---____ -------------------------------------------------------------------------------- Remodeling and/or repairing (describe'):------------------------- - ---------------------------------•------- ------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. -- ----------- (Signed) - ---------- ------------------ (O �er and/or Contractor) or) " - (Title)--- --------------=----- --------------- --------------------- By: -- -_------- ` - By:.- = (Plot plan. showing size of lot, location of system inpation to wells, buildings, etc., can be placed on reverse side). FOvvvR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY..- / ------------------- �--�----' DATE-----� ---- REVIEWED BY----------------------------------- ---- --- --- ---------- - - BUILDI'NG PERMIT ISSUED------------------------- - --tr ------------•-----•------•-----------•�-------- --------- DATE------ ------•---------------------------------------•------ Alterations and/or recommendations----------- ------------ T Date---l._/..-_ -'��_ 6-------•----------- ---- FINAL INSPECTION BY:_--_L�.- '- SAN JOAQUIN' LOCAL,HEALTH DISTRICT 132 Sycamore Street 814 North "C" Straet 130 South Ameriean Street 300 West Oak Street Y Trac California Stockton, California Lodi, California Manteca, California y h E5'•-9 145446 ATWOOD