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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued © ! — d�O Applica{ion is hereby made to the San Joaquin Local Health District fora permit to construct an install the work herein described. This appiic_atii n is made in compliance with County Ordinance No. 549, _ -- Cr �ff p n J08 AQQRESS AND LC3CATION... �- �----��-----�--------...�!�a.�._.__..�--•-�c.�"_-- ---•--------------- -------------------C- Owner's Na UU Phone.r,----7-= -- Address-•-...... ------ - `f / ''' ' --- ----- - -------- ------ f- ---- --------------------------- - ----------•-••----------------�-,{�-,---- ----- -- Contractor's Name . - ' Installation will serve: Residence @4--Apartment House ❑ + Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:�__t__--Number of bedrooms umber of baths ___I___ Lot size ---- ___ ____ _Q_____________________________ Water Supply: Public system Lim-Community system ❑ Private ❑ Depth to Water Table._t ft_ . Character of soil to a depth of 3 feet: S;;� ❑ Gravel E] Sandy Loam ❑ Clay Loam El Clay ❑ Adobe��Harclpan ❑ Previous Application Made: 'Yes ❑ No New Construction: Yes ffrlNo ❑ d TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:) W Septic Tan Distance from nearest well-- _--_-_-__Distance from foundation--------_-----------Material________--_____-____________-____-___-____----_-. No. of compartments------------ - -----------Size--------•----- --------•-------Liquid depth-------------------------Capacity----------------------• N ' Disposal ,Rel Distance from nearest well-------------- Distance from foundation-----------------.-.Distance to nearest lot line--------.__---__- fi ��CcSf]tiV Number of lines--------------7- ------Length of each line--------------_---------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------------.------._Total length---------------._______-____:___ r Seepage t: Distance to nearest well.VUVA--------.-Distance from foundation_ ___ Di nce to nearest lot line_______- Kr Number of pits-------_I---------- --Lining material---- l�____---Size; Qiameter_-_ --_---_---Depth-----�!�--��Y£----- � -� Cesspool: Distance from nearest well-----------------Distance from foundation-------.----------- Lining material------.------,------______ '__: ❑ Size: Diarrieter--------------------------- ----------Depth--------------------- ---------------------- ----_Liquid Capacity---------------------------gals. pt, Privy:- Distance from nearest well-------------------------_____-_--_------. ----Distance from nearest building____-_____-______g.!'l_ ___-___--- ❑ Distance to nearest lot line----------------.------------•----------------t--•-------------------••-------------- - , - ' Remodelin T a d/or repairing (describe):---- U P --- ...-... - 11 , -------------------------------------------------------•-•-------------•--------------------•-•-------------------- ------ --------- 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, andrulesand regulations of the San Joaquin Local Health District. .-t�.. -------Owner and/or Contractor) (Signed) -- --- ---------- --------- ------- ------------------------------------ -------- BY� �-'� --------------------------- (Title) 2 (Plot plan, showing siz f lot, location of system in relation to wells, buildings, etc., can be placed on reverseide). /Z FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------••-••---------= DATE__._ REVIEWEDBY---------- ------------------ ------ DATE_--$ - -------- -- ------------------------•--_-' BUILDINGPERMIT ISSUED--------- ----------------------------------------•---------------------- ------ DATE.. --V;:---------------------------------------•-------- Alterationsand/or recommendations:------------------------------ ----------- ---------- ------------------------------------------------•-•-------------_._.----•------------------------•-•- -----•---------------------•----------------------- ---------•-------------------------------------------•--------------•--•------------•-----------•-••--•---•------- ---------------------------•----------------------- FINAL INSPECTION BY•- - - - ------ ---- - - -- -------------_----- Qate - r 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 145446 ATWOOD