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u�l�,. APPLICATION FOR SANITATION PERMIT Permit No- -- - --J-" V (Complete in Duplicate) Date Issued ._ '_- Applica+ion 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 AND L CATION_ ___.cf-��- m G Owner's Name_____ a __ _____----- -- _ - ----- ----- ------ -------------------- Phone--- Address---------- . Contractor's Name---_O.''ev..... ... ------------------------•----------- --------------. Phone- d - ------------d 7 -_ Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------------------------------------- Water Supply: Public system�O Community system ❑ Private ❑ Depth to Water Table 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 sewer is available within 200 feet.) Septic t 1 - istance from nearest well------ ----------Distance from foundation__------ -------Material o. of compartments--------------------- ----Size----------------------------•---Liquid depth--------------- --------Capacity----------------------- Disposal��V!nmber ante from nearest well---------- .-Distance from foundation-_-.--_..____--.-_-Distance to nearest lot line_________________ of lines:---------------------------------Length of each line-------------------------------Width of trench Type of filter material......................._Depth of filter material---_----.--._---_---__Total length ---••----- --- Seepage Pit: Distance to nearest we4--- -/VC----Distance from .o.undation----A01--------Dista.,�c-_e-__t--o- nearest i e_ vNumber of pits._!l---------------Lining material_-_ Diameter__._ Depth :- Cesspool: �►��___ Distance from nearest well------- -------Distance from foundation------------------ material________....__.-____________._- i ------ ❑ Size: Diameter ---------------------------------Depth----------------------------------------- Capacity.. g , # - -------Liquid gals. Privy: Distancelfrom nearest well___.---------------- -------------------------Distance from nearest buildingW ❑ Distance to nearest lot line---------------------------------------------- ------------------------------------------------ Remodeling and/or repairing (describe)---------------- -------------------------------•------------------------------------..-..---------------------------------------- - --•- --------•--------------------- ----- --•--------------------------------------------------•-----------------------------------•----------------------------I ---•---------------------•-----------------------------------a I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St7�e� and rules and regulations of the San Joaquin Local Health District. (Signed)---------- - = . WY -- ------ �z-------------------------- Owner and/or Contractor) By:._ .. --- - � ------------------------- --------- ------(Title)------- --- - ------------------------------------ (Plot plan, showing size of lot, location i of system in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION AC- CE-PTED BY.- - - -- - ------------ DATEBY ------------------- '------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------•-------------------------- - ------------------------••---------------------------------- ----- DATE--- ---------- A terations and/or recommendations--------------------------- ----------- -----------------------------•_------_ ----------------------------------•----- -----------------------------------------------------------------•-------.------ •-------------------------------•----- � � rS FINAL INSPECTION BY:--- ----------------------- 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