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APPLICATION FOR SANITATION _PERMIT Permit No. ___ _!_ __t-____-- (Complete in Duplicate) a 1 S b Date Issued -------�__-- plica}on 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 LOCATION----------- -------- ------------ -a Owner's Name.-------.0 rh e -------------------------------------- -------------------------------------------- Phone-------------------------- Address----------°?o 4L •--•--•-- lj -------- ---------------------•----------- ------•---------•--------------------------•--------------------------------- Contractor's Name------ lL1lll�L dV------cl-S— z --------------- ------------------------------•-----•--•---•---- Phone/-J�a Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A ---- Number of bedrooms -4. lumber of baths j____ Lot size _____7- '_.y-_:%S. ._________._-_-_.__._ Water Supply: Public system 91. Community system ❑ Private ❑ Depth to Water Table - - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeQ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No W, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T �' 11,1ance from nearest well_________________Distance from foundation------------------Material------------------------------------------------- ❑ of compartments--------------------------Size----..--------------------------Liquid depth.-------------------------Capacity----------------------- Disposalield` istance from nearest well.................Distance from foundation--------------------Distance to nearest lot line-_-_.___-_.____- ❑ ber of lines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- T-ype of filter material-------- ..............Depth of filter material---- -------- ---------Total length___.__________________.______.._._______._ c Seepage Pit: Distance to nearest well___/'((—-___Distance from foundation___. >G._______.Distance to nearest lot line........ Number of pits--- --------------Uning material_C"!�_ �—'�-?ize: Diameter___. t.r___Depth-----.-2r.C7-1-------------- 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 and/or repairing Idescribe):--------------------------------------------------------------- ----------------------------------------------=-------------------------- ------------------------ ---- --------------------------------- --------•-------------------------------------------------- -------------••--- ------------------------------------------------------------ - I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aw , and rules and regulations of the San Joaquin Local Health District. I - .- �-'r---- _ (O ner and/or Contractor) (Signed)----------- --- --- --- ---------- --- ---- - BY� ----- •- - ----- (: - --------•------ -----(Title)---- -- -- --------eF -------------- ----------------- By: 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------�----------- ---------------------------------- REVIEWEDBY-------------------------------- ! DATE-------- __---�-------.-._..----------------------- BUILDINGPERMIT ISSUED--------------- !� --------------------------------------------• • DATE------------- --- ------------------- Alterations and/or recommendations:—.--- -------- ------ ---------- - ----------------------------•------------------------------ ..-.- --------------------- -- ---------------------------- ------------- -------------------------------------- ------• ------------------------------------• ----- -- ----•--------------------•-------------------------------•--------------- ---------------------------------------- --- ------------------- ------------------------------------------------- ----------------------- ---------•- ----- ----------------------------------•----------------------- FINAL` INSPECTION BY:.. -------------------- •----- D --- - ----a-------Q� -- ---- - 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