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'h 0, 1 APPLICATION FOR SANITATION PERMIT Permit No. ... __._1S-]1 (Complete in Duplicate) �Com p Date Issued ______lP___r7_ pliceion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4A�This application is_made.in.-compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------4AIII,�f�I/1y� 200- Sift----- -------------------------------•--- C ------------------ Phone-----------•---------- Owner's Name-------------k., �-----• �12C -------- b z?� ------.In-....�Y .� - ---------- Address-----------------------------------------••---------------------------- -------------------------------•---•--- --•------------------••-------------- Contractor's Name------------------ ? a� - Phone. Installation will serve: Residence I$- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other .W G� G� r Number of living units: -------- Number of bedrooms -------- Number of baths __ .._ Lot size -------- ....................... Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ :Gravel []'-Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ � 1 Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. Septic Tank: Distance from nearest well__ __1YL7----Distance from foundation__ /0---- Material......:......!."�-`.------��_________- 1 l. Af No. of compartments Size... -'v L ---Liquid depth---- -------- - Capacity... --------- ---- -- ' � Disposal Field: Distance from nearest well----- ....Distance from foundation------ _-'__Distance to nearest lot lines_-r�___:. Number of lines________________ Len th of each line__ o - _ "9S Width of trench----------2'` --_-.-.-._______ Type of filter materiaL__.._. Depth of filter material-------M-...____._Total length--------_____7�'___._________..___.--- Seepage Pit: Distance to nearest well ..............__-___Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number,of pits----------------------Lining material---------------------- Size: Diameter-------------- --------Depth--------------------------------- Cesspool: Distance from nearest well---------_-------Dist~from foundation----..-...---------.Lining material----------------- ---- ____,_____- Size: Diameter -------- ---=._,Depth--------- ----- - --.-. :�:_ Liquid:GapacitY gals: Privy: Disfanre from nearest well----------.--- -----------------------------.----Distance from nearest building____..____.__.___________-_-____...______. I ❑ Distance to nearest lot line---------------------- ------•------- ---------------------------------------- ------------------------------------ Remodelingand/or repairing (describe)----- --- ----------------------------------•--•-•-----------------------------------------------•-••-------....-•------------------------------ -------------------.......•------------------------------------------------------------- ------------- ------•--------------•---------------------•---------------------------- = -------------------•---------------•-••------------------------------------•--------------•--•--------------•- ---------------------------;----------------•-•----------------------•---------------••------- ------------------------------------------------------------•------------------- ---------------------------•------------------•---------------•--------------------------•----------------------------------- I hereby certify that•1 have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, tolaws, and rupee nd regu t' f the San Joaquin Local Health District. r fr - ------------------------------- --------------------------------------- --------------- (Owner and/or Contractor) By:......................................•-------------------------------- ----------=---------------------------------- --- ----------(Title)------------------------------------ -- ------- (Plot plan, showing 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---------- -------------- - =j;,..� REVIEWEDBY------------------------------------------------------------------- -------------- - - ------------------------------ DATE------ ----------------------------------------------------- BUILDING ---------- -- - ----------•--- BUILDING PERMIT ISSUED------------------------------------- ---- -------f` - DAT ` ------------,-- --------------------------------- - - ------ - � �Alterations and/or recommendations:---- -------- ---- -- - ----------------- ----------------------•-----------------------•---------------------------- ------- ---- I------------------------------------------------------------------------------------------------------ ------------------- ------ FINAL INSPECTION BY:------ ---- -•------------------- Date. - U 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 12-54 i