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APPLICATION FOR SANITATION PERMIT Permit No. .-.��.. �. (Complete in Duplicate) ,1?_� _l 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• a� o�-9 9 Hwy Ala -t-o tet*L t e-a pi JOB ADDRESS AND LOCATION--- _ -to- _J;4=;;_ - _,&-a Owner's ------------------------------ Name----- /._ t._'t'_--'----- � 1 ------------------------------ •-••------------------ ------------------ -=- ._ Phone------------ 77L � Addressr'---------------- "f -------- --------- Contractor's Name....... ------ - -- -----------------------•----------------------------------- Phone---------------------------------- Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./--_. Number of bedrooms --2. Number of baths/-_---_ Lot size _-__._ - '.-------------••---------------------- Water Supply: Public system ❑ Community system ❑ Private tig- Depth to Water Table __tO ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ED.Hardpan ❑ Previous Application Made: Yes ❑ No [8- New Construction: Yes EA No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel!_-,-_.____------Distance from foundation.__---------------Material-_._._------.-..-_._---.-._._......-______-_----. ❑ f pof compartments----- --------------------Size--------------------------------Liquid depth--------------------------Capacity------ ----------------- Disposal Field: Distance from nearest well- found _---Distance to nearest lot line---W..... ®_ Number of lines------------ __-_y..-_ Length of each line....__�_��r--- _.-Width of trend _ " i �� Total length---. —°"' Type or filter material-_fes`___... RDepth of filter material.__.__. ........... I Seepage Pit: Distance to nearest well A...----..Distanceff om foundation------��__.Distance to nearest lot�li e_ _.-�-- Number of pits------/-..---.-.___,Lining material-_-(� _0_S-_Size: Diameter-______ '__ _Depth------- .--.__---.-_ Cesspool: Distance from nearest well_ _______________Distance from foundation--------------- Size: Diame#er.------------------------------------Depth---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well----------------------------------- ---Distance from nearest building_._-.-----.--.----.--..-__.--._-.-.--.--. ❑ Distance to nearest lot line-------------------------------------------------•-------------------------------... ------------------------------------------------------- Remodelingand/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 a. s, and rules and regulations of the San Joaquin Local Health District. (Signed)---------V------- --- -- -- °------Y --- ------------------------------------------------------------(Owner and/or Contractor) By:_---- -- - ------ ,�� ".. ^ , _ '-' ------(Title)--------- �----- ----•------------ ---------------- \n . (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE ---------------------------------------------------- REVIEWED BY ---- j ----------------------------------------------------------- -... DATE_ ---------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------.-.------------- DATE.-- .... Alterationsand/or recommendations:_. ------ -------------- --- ----------------------------------------•------------------•-•---------------------•---•--------•---- --•----------- ------------- -------------------------- ------------ ------•-------•- - ----------•--------------------------------------------- - ----------------------------------------------------------------------------- FINAL INSPECTION BY Date- ---------- - - - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sheet Stockton, California Lodi,.California Manteca, California Tracy, Californt! ES-9-2M 145446 ATWOOD 12-54