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APPLICATION FOR SANITATION PERMIT Permit No. ..../ .. _.. (Complete in Duplicate) �- Date Issued --------1_��__- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and i stall the work herein described. This application is made in compliance wit' County Ordinance No. 549, i,� Jy(G JOB ADDRESS AND LOCATION--Y_-- "s. ..0 ?� ` -------- J " , ---- --_� 1 + .• Owner's Name ..._ _ /j ---- ------ ------ ------------------------------------ Phone. Address_----... ----�° t ------�,.--. ---------•• .. Contractor's Name____ :_. - rh _. 'Z ................... Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_-_ Number of bedrooms _- Number of baths -- tot size ______/4� Water Supply: Public system ❑ Community system ❑ Private E'Depth to Water Table ; ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3- Hardpan ❑^ Previous Application Made: Yes ❑ No E�} New Construction: Yes J2—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwy --Distance from foundation__.2e------...Materia f._ _ ___f 2 t_ ___. No. of compartments------ ______________-_-Size__> __ _' _ ____Liquid depth.___.!__.' Disposal Field: Distance from nearest well_w,�-------Distance from foundation.__ Q__ _._._.Distance to nearest lot line49___..... Number o' lines_________ ______ )Length of each line______ , .__.___y�__.Width of trench.______ ��** Type of filter materiaL__!_�_. Depth of filter material______lrf________Total length___.____.�f_Q_ _ Seepage Pit: Distance to nearest well__// ...______Distance from foun , tion___/Z�___.__.Dish is to nearest lot line__e�-____- [4" Number of pits.__.___s2�-----------Lining mate riaDiameter____�.....___.....Dep o------120_----------------- \� 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_._________._._______ ❑ Distance to nearest lot line--------------------- ------ ------------------------------------------------;----------------------------------------------------------- Remodeling and/or repairing (describe)----------L----& 1 */ #- ----------- --- �-— ------------------------------------------------+ -------.----•------------------------------------------------•-------------...----.----------------------------------------------------------------.---------.-----------_--------------------------------------------------- ------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i 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 reglotions of the San/Joaquin Local Health District. Signed --- -- ----------- -- �'L- �-� "' JC '--------- r Contraci ,r 4 By:-------------------•--.......... -c ......... --------------------------------------------------(Title)--- (Plot plan, showing size o t, location of system in relation to wells, buildings, etc., can be placed on reverse sid� FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY----- -- - ------- ---------------•-------•--•---•--------- DATE - - - - - - - - -- REVIEWED BY --------------- .. --------------------------------------------- DATE _.. } BUILDING PERMIT ISSUED------------- ---------------------------------- DATE DATE--------------- --------------- r recommendations: -------------------------- ------------------------------------ Alterations and/o'and o �- --------------------•--- ' ---------- ------------ --- �� ------ ;ab- - -. -�.. l: x ...._... ---------- --------------------------------------------- ------------------------------------------------ - ----------------- ----------------------------------------------------------------------------._....,_.---• ----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------- ------------------- FINAL INSPECTION BY:-----r r ------------------------------------- Date------- �� ----------------- --------------- y:r-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Sfree! 814 North "C" Street ` Stockton, California Lodi, California Manteca, California Tracy, California j///jES-9-2M 145446 ATWOOD 32-54