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APPLICATION FOR SANITATION PERMIT Permit No4151/6--6 -------- ------ (Complete in Duplicate) Date Issued Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a I' mqd91 in co l� with County Ordinance No. 549. JOB AD RES A P�Dl rRg!E S FA CT N -- ----------- :1!!!11:: C. Owner's Name - ---------%----------------------------- --- Phone 7 ----- ... -----------4L. 4 Address.._..----- ----------------------_-- Contractor's Name...-- --------------------------- --------------------------- Phonalx,� Installation will serve: Residence 5L_ Apartment House [] Commercial E] Trailer Court [] Motel E] Other J-] Number of living units: ----- Number of bedrooms __ Dmber of baths Lot sizes --------------- Wafer Supply: Public system JZ--.Community system El Private Depth Depth to Water T"*e _-Z-4-5 ft. j Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam 0 Clay Loam Ej Clay E] Adobe N- Hardpan E] Previous Application Made: Yes E] No El New Construction: Yes A- No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- istance f m foundatlon__,/d------------Material---C-C.-13-1 - No. of compartments---- -------- -549: --Size.-- Liquid. clepth----�Z-----------C a p a c i ----------- Disposal Field: Distance from nearest well- istance from& foundati!!n__ ,__ r-----Distance to nearest lot -- ---- ---Length of each lina&_ __Width of french-. Number of lines_____ ------------- Type of filter material___. LDepth of filter material_._._ ! -----Total ---------------------- Seepage Pit: Distance to nearest we1l_,4/0%X__,Disfance f fou tion_-- or_.Distance tp nearest lot line Ole_ Number of pits---/---------------Linin material;X_4------- iz : Dia meter-----19�:r ____ Depth--- --- 9L Cesspool: Distance from nearest well_________________Distance from foundation.-..-.___.-___.__ Lining material r ---------------------- El Size. Diameter ---------------------- -- -------Depth-.----------------------------- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well. -- _________________________________________Distance from nearest building___---___.__.-.---________._-.__--__.___. ❑ uilding--------------------------- ------------- El Distance to nearest lot line------------------------------------ - ------------------------------------------------------------------ Remodeling and/or repairing (describe):-, .---------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------ -------------------------------------------------------------------- ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------I——---I-----------------------I--------I------------------------------ ------------ ------I--------------------------------------------------------------------------------------------------------*-------------------------------------------------------------------------I-------I---------.----- I hereby certify that I have prepared this application. and fkaf the work will be done in accordance with San Joaquin County ordinances. State j1gwe-, ipd rules and regulations of the San Joaquin Local Health District. (Sign ----- ----- --- -- -- ------------ -----------------------------------------------__AO Yper and/or Contractor) . . ...... --- By:- ---- --- ------- ------- -------(Title)------ -------------------------- - ------- (Plot plan, s owing. size Of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - --------------- - ... ........ ---------------------------------------- DATE-_ -" - ------------------------------- REVIEWEDBY-----------------------------------r- --------------------- --------- ----------- --------------------------------- DATE--- -------------_ BUILDING PERMIT ISSUED---•--••-- ------- ------------------ ----- - -------------------------------------------------- DATE------------------ , Alterations ATE------------------- Alterations and/or recommendations:.................. -- ---- ...... .. -------------------------------------------------------------------------------- -------------- - --------- --------- --------------------------------------------- -------------- ---lz�------------------- ----------------------_ --------------------------------------------------------------------------- ----------------------- ----------------------- ...... ---- ---------------------e ___0 _ - ----------------- ------ --------- ------------------------------------- - - -------------- -- ----------------------------------------------- --------- ---------------------------------------------------------------- -------------------------------------------------- --------------------------- ---------------------------------------------------------------- ------------------------------------------I---------------- �FINAL INSPECTION BY:---- ------------------------ ------------- Date_.. -©-`-- ;�---------------------------- 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 E5-9 145446 ATWOOD