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w A_ �../ APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) / i Date Issued�P/:%-------- Applica-i-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. 2/ �-a JOB ADDRESS AND OCATIO - ----------- % --- -- --- � � ( ._. _ ._ _._^------------------ ••---------------------------------------------------- u/ ---------------- Owner's .-.--Owner's Name---------- I Q /r" --r---1 Phone- Address-_----------------- honeAddress-- ----------------- Contractors -----�----'-- Name------ --- - �- `� --------------------------------------- Phone-242 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motelx Other Number of living units: J7__ 1Number of bedrooms 17- Number of baths/1--- Lot size -------------------�- h'��'"'.- . � Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table -------- ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay (] Adobex Hardpan ❑ Previous Application Made: Yes ❑I Nox New Construction: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) } ept c Tank: Distance from nearest well------------------Distance from foundation------------------ Material--------.---.-------.-----__------_- ----------- No. of compartments------------ - -----------Size.---------------------------•---Liquid depth--------- -------------- -Capacity----------------------- isp sal, ieid: Distance from nearest well.----------------Distance from foundation--------------------Distance to nearest lot line--------------- ` + Number of lines-----------------------------------Length of each line ` U line------------------------- -----------------------------_Width of trench Type of filter material-------------------------Depth of filter material-----------_-----------Total. length ------------------------_ _-- length-------------------- --------------_----- Seepage --.--- ----__Seepage Pit: Distance to nearest elf_/D4-__-__-___Distance from fou dation--'_G� I' o7D a ____.--.Distance to nearest Iof ine-------------_-- Number of pits-_ __ -------- Lining material0, -t- Size: Diameter.--�e.r__..-Dept'r�':-- % _�--;-y., -T�__ Cesspool: Distance from nearest well from foundation.-__.............. Lining material El Size: Diameter---i ------------ - - ----------------Depth----------------------------------------------------Liquid Capacity---------- gals. Privy: Distance from nearest well--------------- ---------_----------------------Distance from nearest building �+ ❑ Distance to nearest lot line-t....-. ------------------ Remodeling and/or repairing (clescribe):-------------------------R-• ......I-----------------•-•-------------------•---------- --------------••---•--=---------•-------------.-.:_..---------•------------' ---------------------�-----•----------------------•------------------------------------------------------------------- --------------- ----------- ------ � 1 ---------------- .-� I hereby certify that I have prepared this application and that the work-will ,be done in accordance with San Joaquin County ordinances, State laws, and rules and refions of fhe`San Joaquin Local Health District. (Signed) - Oner ----- -------------------`-------------- --------------------- -- --------------------------------- -( and/or Contractor) ------------ ----- By:----------- ---------------------------------------------------------- Tifle ( - ---••-(Plot plan, showing size of lot, location of system in relation to wells, burldings;�etc.;can be placed on reverse side). f FOR DEPARTMENT USE ONLY-j., APPLICATION ACCEPTED BY................... ----------------------------------------------- DATE------- --- REVIEWED BY----------------------------------- � y � --------------------------- DATE-------- --------- . BUILDING PERMIT ISSUED-------------- ----------- ------------------------•--------------------------------------- DATE_---------------- Alterations and/or recomm ndations: =-- -------------- ---------------------------------------------------------------- ------... 4 I ,. -- ---••--- ---- ------------------------------- -- -- -------- -. --•-.----.- - W...-.--_----- -- --_.....-._-----_.-.-------__••_---.---..---._-•-•-_-•--_.-. -N----•__••-_-_____--..-_.... -----------------------------------------------------•-------••-----------•-------- ` -------•--- ... •---•------- '-' _- -------------------------------------------------------------------------0------ ---------------'- ----- --------------------------__- --"""----------...-----I-----------••----••'------------------------------••--- ------------- -----------------------------_-----------------------.--------------------•----------------- 4 FINAL INSPECTION BY:--- -----------------------•- ----------------- Date---.. .."' SAN JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Street 300 West Oak Street �� 132 Sycamore Street 814 North "C' Street f Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M 145446 ATWOOD 12-94