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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S r _ _ . ., _ a Date Issued 3 -fi 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 C N- VO--------I ------ / Q k ---- -�U Owners Name---------- -/- --- - ----- ---- - -- ------ -- ----------- - -- - -- --------------------------------------- - ----------------------- -------- -. Phone------------------------------------ Address------------------------- ----- IIIQ._"... 1!!/d �-Q �._.. -----------------• --••-_-----•- Contractor's Name------- ---- ------------- --------------------------------------------- Phone.- - G Installation will serve: Residence Eff- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: ____ Number of bedrooms -._ Number of baths -_ Lot-size ------ �fi�'(�_ -------------- --- - --------------•-------- Water Supply: Public system ❑ Community system ❑ Private .R- Depth to Water Tabled_ it. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RL_ Hardpan El Previous Application Made: Yes ❑ No �N_ New Construction: Yes No X-_ TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . l Septic Tank Distance from nearest well—YO---- Distance from foundation.___.Z6__._......Material---- - ;.No. of com artments_._ . _------- -._Size_.__ -___�-�' •9uid . ------Capacity-----�---------•-• Disposal Field: Distance from nearest well----- _..... Distance from foundation__s;?_�0........Distance to nearest lot line....Z!q_ -- Number of lines___:'. _ _ _ :_ .___:_ .__�______Length of each line_ ._�_�t._`.` r� .Width of trench __- ---`_______________ � Type of filter material.",�_� 5.1ee th of filter material....___._ __ ,Total length......��7 a Seepage Pit: Distance to nearest welL.Il_D_.____Distance fr foundation__--�'v�____.Distance to nearest lot line___� _�_. Number of pits.__._...___-__.__Lining material____ _ G_Cr Size: Diameter-__.___ p ' De tri Cesspool: Distance from nearest well_________________Distance from foundation-----------------__-1ining material__._.__-.__.--_._._.___.._A._________ ❑ Size: Diameter------------------ ------- ------Depth----------------------------------------------------Liquid Capacity--- ------------------_--gals. Privy: 'Distance from nearest well-----------------------------------------_---------Distance from nearest building----_--------_.----------------- :_" �� ❑ Distance to nearest lot line-------------------------------------------------------------------------=----------------------------------------------------------- - Remodeling and/or repairing (describe}--------------------..------------------ ------------•-•-----•--•-•----•----•----------------------•-------------.....-----•-------•---------------•-------- ----------------- -----•---------------------••------°---------------•-------- ------------------------•-----------•-------•-------•------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ________________________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules and regulations of the San Joaquin Local Health District. Owner and or Contractor (Signed}.... --- - - - ___Title y- __ BY� - ------ - --- ( } � (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 APPLICATIONACCEPTED BY- ------ - -------- --- -- -- ------------------------------------------------------- DAT ----- ------------ ------------------ ---------- REVIEWED - REVIEWED BY-------------------------- ---- ---- -------------------------------------- -------- DATE---- ---- -- BUILDING PERMIT ISSUED----------------------------------- -- ---------- -- -------------------------------------------- DATE----------- y Alterations and/or recommendations:--------------------- --------------------------------------------------------------------- ------------ ----------------------------- -- ------•-•--------------------------- --- �- - ---- { - ---------------------------------- -------------- -------- --- --------- '—---------._.d n- - _ _ _--- -�- ---- --------------.----------------- ----------- FINAL INSPECTION ---------- Date---G--- _�__- �- :- -------------------------- - - - - -- -------------------------------------------- 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---g - i49446 ATWOOD 1