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3 y� ys f l kr Q Z ,�, � - - APPLICATION FOR SANITATION PEhrAIT Permit No. t 1 1 (Complete in Duplicate) $ z Date Issued .-- .?t�A. -... "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 compliarice,with County Ordinance No. 541. � ��.•-�;'` ADDRESS AND OCA ION__ ' vw -:`___ -------•--------••---- -------------------------------------------------------------------------------- .4 -- JOB . � tr FOwner's Name------------- ------------ J ----------------------- ---------------- Phone...--------------------------- Addr •---�---- - Cont for s3�Z_ me__.----- - rF -------------- ----------•----- Phoneme--< • --------------------I r Installation will serve: Residence ❑ Apartment House ❑ Commercialfrailer ourt I-] Motel E] Other E] Number of living units: -------- Number of bedrooms -------- Number of baths s___ Lot size ------------------- ------------------------------ Water ____________Water Supply: Public.system,❑ Community.system ❑-Frivate.p� 'Depth to Water Table -------- Character ___--Character of soil to a depth of 3 feet: Sand ❑ Gravel,0 Sandy Loam ❑ Clay Loam ❑' Clay ❑ Adobe ❑— ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [L}___ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank oravailable r cesspool permitted if public is availy a ithin�200 feet.) Sep tic Tank: Distance from nearest well 11 �� _.-------Distance frpm foundation_ _ -_'-._-Material------- _.__--- ' `._.__.._.. ❑� No. of compartments-------rc-_----f-�-Size---`��---------------------Liquid depth----� ..-------._Capacity----Z Disposal Field: Distance from nearest well_.........Distance from foundation_3_a.._____._.Distance to nearest lot line___ [� Number of lines------- ------------Y� _ _ _ Length of each line____ + --------- Width of trench-___ . ------ ---------------- j r / ! I! Type or filter matenal..�r_. Q_��'Depth ofxfilter material___-/.�__.__-_-._.Total length_____. _0--e----4aP-R�.__- .. Seepage Pit: Distance to nearest well- Distance fr m� f undation----- to nearest lot lin�___.__________4C] Number of pits_____. i-----------Lining matarial__� "�'_---Size: Diameter____��•��__-_____Depth _____ -S_-__--___ Ces � well � � � � -- spool: ¢' Distance from nearest ___ _�_--_Distance from foundation._..��_�----...Lining material__..--_-._ _.__ �. / �.. • (%l�r�� Size: [(Diameter---.... r Depth �f+` -----Liquid Capacity------7 ----------gals. TF z Privy: Distance from nearest well__________________ --------------..----------. ._Distance from nearest building-------------------------------._.__.._._. ❑ Distan:ce to nearest lot line----------------------------- ----------------- --------------------------------------------------------------------------------------------- _ Remodeling and/or repairing {descr;bel_-------_-------------_------------------------------------------- ---------•---------------------------------------------------•-----------------------------------------------•------------------------------------------------------------------ -------------------------------•----------•---=-------------------------------------------------------------------------------------------•-------••--- - ------------•---------•----•:•-•------------------------------- -----------------------------•---------------------------------•-------••-•-------------------------------------------------------•-......_---------------------------------------------------------------------------- I hereby certify that Fhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and-mgulations of the San Joaquin Local Health District. (Sigoad}-------- --- --------�s --------- J ` �---'` ---------------------- (Owner and/or Contractor) (rifle). (Plot plan, showing size of�lot, location of system1m relation to wells, buildings, etc., can be placed on reverse side). wFOfR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- `--------------------------------- DATE----- --- --- ---------------------- ` REVIEWED BY-------------------L--------------- --- - - ----------------------------- ---------------------=----------------------- DATE ---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ --------- DATE------------------------------------------------------------- Alterations and/or recommenda ------ --------------------------------------------- •----------------------- - - �- .. ------------------------------- --- --------- p --------------------_----------------------- ------------..____..--.___.._._.______.L______________.._____-..____...___________.______._..__.____-__-_____.__.________._.-..._________.__________.__________-__.__._._._.... — - ------------------------------------ ____________ __ ___________ ____ __a1_..__...... -------------------__-...._______..____-...__.-----------.------------------------.-----------._..____________.____._..._._............ NAL INSPECTION BY:_____.(j -- --- -- -f- - ------ ----- ------- Date---- --'-------- -------- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 3 E5---a-2M 145446 ATWOOD 12-54 f