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I' APPLICATION FOR SANITATION PERMIT Permit No. ........................ f. £� y (Complete m ( fit' f- 1 ' . -7- , - e sue Dat i s d Applica ion is herekiy made,to;�he 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. l �x.�`'�- Lam. / 'Yl f. W_ ! ' ------ "' ... ..�1. JOB,ADDRESS A OC TION...._. 11 Owner's Name_ - - - r---- -• -�-- �-� ------------------------------------- - - ------------------- --------- Phone--------------------•-�------------- Address-- rr� 11 rt -----•---------------".-----------------.--------- Contractor's Name-----, --- -------i( ---------------------------------------------------------- Phone----------------------------------- linsfall1lation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ lk Number of living units: __�__._ Number of bedrooms _`Number of baths ._._-/_ Lot size ---- ------------------------- Water ---------- ------------- Water Supply: Public system J Community system ❑. Private [] Depth to Water Table 400 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No N New Construction: Yesi] No El TYPE'OF INSTALLATION AND SPECIFICATIONS: `I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__. -4>IA—Distance from foundation__,t Al..._--_..Material--e-a_ '`- No, of compartments-... • com artments_...__-_ ........ Liquid- Li uid de th.-__ 2 - _ ________Ca acity-- -��`- I� Disposal Field: Distance from nearest we11/. _AZ --.Distance from foundation_:_/g._r____.__Distance to nearest lot line----V1______-- Number of. lines__________ ___Length of each line-------- - - Q__ ....width of trench______ ............... Type of filter material____/_s..___5.._R---.Depth of,filter material__._: ---Total length____-.._... _---__________________ Seepage Pit: Distance to nearest well---A1t>LLDistance from foundation_____ Distance to nearest loft fine__._/A__�___- et Number of pits_____._.__________Lining material- �J*e! �e: Diameter__.__., _. Depth_,__.. !_--_______ _ Cesspool: Distance from nearest well-----------------Distance from foundation._'. . .Lining material-------------------------------- Size: Diameter_________________ ----- - ------Depth ._______.----------------------------- -- .__Liquid Capacity-;-----------------r--------gals. Privy. Distance from nearest well-------------------------------------------------Distance from nearest building__._________.______________________-_._. Distance to nearest lot line ------ -------------------------------------------••-------------------------- -- - - Remodeling and/or repairing (describe)_---------_----------------------------------------- b--------------------------- ------------------•------••----•------•---•-----------------------------------------------=---------- - --------- -•----------•--••--•-----------------•••-------------------••---•---------------=-------------•-••--------------------•---------------------•----------------------------------------- -- ----------------- ------------------------------------••--------------------------------------- - = ------------------------------------------------- I hereby cert' hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf law and rules-and regulations of the San Joaquin Local Health District. (Signed)-------- ----- - --- -------- --------------- - ----- ---- --------- --------------------------------------- ------------------------------ -------(Owner and/or Contractor) --------- Title I BY' ( � ------------ - ----_ (Plot(pian, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). a 11� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ _. ------------------------ DATE-----szS��--------- ----- --------------------------- --- REVIEWEDBY--------------------------- --------------------------- ------- -- -- - ------ ----------------- DATE--------- ��- BUILDING PERMIT ISSUED ------ - -------------•----------------------------------------- DATE------------- = --------------- --- Alterations and/or recommendations:-- ''` �----------------------------------------- :; ::::::--- ------::::: I :::: ::::: : : :::::: : :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Y ----------------------- --------------- -------------------------------------------------- --- ---- ------------,-------- ................. ...... ------ ------------------- -----------------------------------------------••-----------------------------•--------------- c FINAL INSPECTION BY:-----" -------------------------- Date--- - --------- J ------------------ n SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street .132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California u E5-9 145445 ATWOOD