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74/ ^.O' U �\1� APPLICATION FOR SANITATION PERMIT l S Permit No- . ....__._._.•.._.. (Complete in Duplicate) Qn Da#e Issued'Apf�ca+ � 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. JOB ADDRESS ANp LOCATION-.._ y.. Z t^► ........ -----------------------_-_ - ------------- Phone------------------------------------ Owner's Name__ J 7 Address---------------_---_-- ........... --------- - - - --•------------------------- .-- --- Contractor's Name--- Phone_ �'� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ........ Number of bedrooms -------- Number of baths ........ Lot size .......... ........................... ................. j Water Supply: Public system X 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 ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public er is available within 200 feet.) Septic Tank: Distance from nearest well__,--_ :- istance from foundation___________________Material...._.._.__.__.__..._______ 0 No. of compartments--------------------------Size............................._Liquid depth -._-_--_--.--_.--------. Capacity....................... Di s osal Field: Distance from nearest well-__---..-_.-_Distance from foundation_---___-.-------_.Distance to nearest lot line................. .............. Number of lines---------- ---- ----------_ _ ---Length of each line------------------------------Width of trench. . Type of filter material ---- ------ - -- ---Depth of filter material-----------------------Total length___-_:.. ______-!y ................ 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-----------------Distance from foundation___.----.-.--_--..Lining material-__.-_---------.----_-___--•-_--_--_. ❑ Size: Diameter-------- - ----- - --------Depth------------------ --- -----------------Liquid Capacity .gals. \ Privy: Distance from nearest well---- -----------------------------------------Distance from nearest building------------ ....................... ❑ Distance to nearest lot line.-- -------------------- ----------------- ---------------------------- Remodeling ------------- Remodeling and/or repairing (describe): - ' ----- -------- •------- • ---, - to -----•------• ---------------------------------------•I �-------•-----------•----------------•------ •-•--- -----• --------------•----••--•------------•----- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,, a aws an and negulations of the San Joaquin Local Health District. (Signed)-- ....... ---••----- --------- -- --------------------- -------------- ---------------- ----=-( and/or Contractor) B • --- --- ----- - ----------------------- - -- ---------- (Title ------------ (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- --- ------------------------------------------ ........................................... DATE.. — ---------------------- REVIEWED BY.. - DATE ..... .. -------. BUILDINGPERMIT ISSUED----------------------•- .............................................. DATE-----•--Vir;------------- Alterationsand/or recommendations:------ - ------- --_----------_...-----•------•------------------------------------------•---••---•-------.----•----••--••-•••--.....------•••... -•-------------•----------••---••••--------------•--•----•-••------•-•-----•-------•------••-•-•-----------•--•-------••--•---•---•--•------•-----•---••-----••-••-......-----------•---•----...•••....•--------------------- -------------------•-----------•------------- -•-------------------------------------------------------------------------------------------------- --------------..................................................... -----------------------------------•-------- ----------- ----•-------- ------------------------------------------------------- -------------. --•-------_. -- ---------------------------------------------------------- y FINAL INSPECTION /BY:............1/___._z/� z -- ...5 -- ----- �'�----------- Date------- -.._..------ ---t-------------------------------------------------------- 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