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I APPLICATION FOR SANITATION PERMIT Permit No. ..5... ----------_ (Complete in Duplicate) 1 /I s 4 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 4 I J08 ADDRESS AND LOCATION / 0 --- -------/�D------------- ----------- ------ --.. _... . _...._.- Owner's Name-------------- -------�--�----�- ---d--- ---- ------ ------------- -------------------------------------- Phone.----------------------------- ---- Address..................11.7__ - - � Contractor's Name— ------------------------------------------------ ----- Phone -p_ v _ __� Installation will serve: Residence .Apartment House ❑ Commercial ❑ -Trailer Court ❑ Motel ❑ Other ❑ I 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 ❑ Previous Application Made: Yes ❑ .No [�r—New Construction: Yes 2 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' . t Septic Tank: Distance from nearest well__,- :el' Distance from foundation-_�d___....._.Material---C--C..-- -11-_- p --------Size 3___--Liquid depth _---- - - [ No, of compartments ..._ p __..--.-Capacity___-_ _�_ -.--- Disposal Field: Distance from nearest well-7--L-xss�Distance from foundation...j-.Cn.........Distance to nearest lot Iine.Sr--____.. + Number of lines.---___-- _ Length of each line------ , ._S' - � - ---- - -------- g � --j - -�• -.Wid#h of trench---��'--��---------------- -- Type of filter material- _ -_ depth of filter material._ Q'`_r_-_.-_.----.Total length-------- --------------------------- $eepage Pit: Distance to nearest well.. .__ _ _ ___ __Distance f o foundation/-.--- --- Distance to nearest lot line_---_- Number of its__ Linin material- te!Ci)iameter_..: 3—�'" �rZ� --------------- p �-- -- g ----------- -- �,�-._._.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.___..______...._____________ \�n -- ----- ----------- ❑ Distance to nearest lot line--------------------- Remodelingand/or re airm (describe):I p g l ibe):-------- - --------------------------- ------•--------------------------------•--------•--•----- •-------------•-----------------•----------------••- �N - - -------------------------------•--------------------------------------••-----•---------------------------------- ---------------------•--------.------•----------•---•--------------------------------------•--------------------------------------------•--------------------•--------------------•_-------------------•--------------------- ------ ---------------------------------------------------------------------------------------•------------------------------------------------------.-----•---------••------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules and regulations of the San Joaquin Local Health District. (signed) -------------------- -------------------------------------------------- Owner and/or Contractor) 13 V. (Title}_ a :_ y--------------------------------------- -- (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-------.._- -- REVIEWEDBY-------------------------------:------------ ----------- -- ------------------------------------------------------------ DATE------------N--------•-•-------------•------.... BUILDING PERMIT ISSUED-------------- _ DATE---- --------------- 1 ----•-.1 Alterations and/or recomm ndati ns:_ --- __ __ _-(-------------------------------------- = ---------------------------6---------------------------------- ------- -------- -------------------- =-==-=- :::::---------------------- --- --------------------- ` � `� �� FINAL INSPECTION BY:. T�S Date. L -'------ ----------- - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca,'California Tracy, California ES-9 - 145146 ATWOOD