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' APPLICATION FOR SANITATION PERMIT Permit N (Complete in Duplicate) 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. - `�, �{Z '- ° l-•1'/._ ----.-- JOB`ADDRESS A D LOCATION__ - jG l / 1 ' ------ Phone----------------------•--------- ` -Owner's Name--------------- -- - ---• ------- -- - -------• - ------------ -------------------------- Address ----------- Address---------------------- --- w------ I --------•---- Phone-------- -------------------------- Contractor's Name Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ ,r Number of living units:I------- Number of bedrooms _'.�_.�_ . NuRmber of baths I---- Lot size __�--- --------•-------------•------ •---------- [I , Community system Private U�? 6epth to Water Table A0_'_ f - Water Supply: Public system El i Character of soil to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam Ug-<_1ay Loam ❑ Clay ❑ Adobe ❑ Hardpan E] e Previous Application Made: Yes, io W----New Construction: Yes No ❑ t- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'publi c sewer is available within 200 feet. oun tion_ -_.__.--__..Mate is Tank: Distance from nearest weil2�;�.__...__Distance�from,f � �--------------------------------------------- Septic No. of compartments----- - --------------Size-/_.,_x- _ Liquid depth Ca acitB--t3--- Disposal Field: Distance from nearest wei�1 00..--x.-Distance from foundafion-0----.-_.t---Distance to nearest lot line_-�------- Number of lines----_A�__.._ ____ 4ength of each line-�j_.1O -.----Width of trench.. -- -_ Type r ,,��jj e► �I T e or filter matenal.__.�+._G�-�__.�_epth of filter material--__�_�-___..__._Total length------ _________ _______________ Seepage Pit: Dis#ante to nearest well______________________Distance from foundation------_----- ----_.Distance to nearest lot line-----------------U-1 Number of pits------ ------------ --Lining material----------------- ---.Size: Diameter------------- Dept^ Cesspool: Distance Distance from nearest well from foundation ------------ --.Lining material----------..-----.-.-----__-----_-_-_. .,.. ❑ Sire: Diameter------------------ ------------- ----Depth- ------------ --------------- ------------ -----...Liquid Capacity gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ V ❑ Distance to nearest lot 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r--C---o--n-t-r-a--c--t--o--r) -- --- - ------ -- -- - -- Title _ "- buildings,,etc.,.can.be-placed on-reverse side]. (Plot plan, showing size of lot, location of system in ielatio -to wells, R A TMEIll jlil� N USE ONL APPLICATION ACCEPTED BY---- ---- - - -- ----------- TE DATE---------------- ------------------------------------------- BUILDINGPERMIT ISSUED--------------•-------------- -------------------------------------------------------- DATE.------------------•-------------------•--------------------- Alterations and/or recommendations------ ----------- ---------------------------------------•--:-----------------------------------------•-----------•--------•-----------•-------------------- ---------- ---------------------------- ---------- •----------- -- ----------- --------------------------------------------- -----•------------------------------------- ---- ------•---•-----------------------------------------------------------..-------------------------------------------------•-----•----------------------------•-------------- ---------------------------- r+ Date =FINAL INSPECTION BY:-----.tel ---------------- -- A ----------•----------------•- 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 ES-9-2M 145446 ATWOOD 12-s4 0