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� o � I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) r Date Issued T l 0--07 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. 544. I;Z-0 S 1�4_,=5,,V0 +4 v . t JOB ADDRESS AND LOCATION--_______ Uj .___ -�!h�.._____.I'I��_I^1Zj...; dt* r� �` 94------•--•- --------------------------------------------- Owner's Name-----------------------•-------- W�•)T!I::-- -�p z--------------------------------------- ----------------------------------------- -- Phone----------------------------------- Address Contractor's Name------------------------------------------ ---------------------------------------------------------------- •------------------ Phone-------------- Installation will serve: Residence 9!�, Apartment House ❑ Commercial F] Trailer Court F] Motel L] Otherz Sh'Y . Number of living units: -------- Number of bedrooms --------- Number of baths ________ Lot size -------- Water ______Water Supply: Public system V 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� a' New Construction: Yes No ❑ ' 3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .� r i Septic Tank: Distance from nearest well__.__. v_-___Distance from foundation------1_6____._..Material__.___._ ` ---__- --�U- No. of compartments.-- --.------n--------Size---7X_q__ j------Liquid depth--------- --------Capacity_---C— Disposal Field: Distance from nearest well------0--�Distance from foundation------)0.........Distance to nearest lot line-------- . Number of lines_._.__'=�:`___ __- Length of each line--------- ------.Width of trench________4y -------------- Type of filter material-------- Depth of filter material._-_----f_Y-(-___Total length________________ Lh/------_- --_----- Seepage Pit: Distance to nearest well------------------_---Distance from foundation--------------------Distance to nearest lot line-------.______._- ❑ Number of pits---------- -----------Lining material -----------Size: Diameter------------------------Depth_ ---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------ } ❑ .Size: Diameter---------------- ------------- - Liquid Capacity- ----Depth--------------------- -•------------------ --------Li a I q P tY- --------------------------gals. a Privy: Distance from nearest well-------------------------------------------------Distance from nearest bu;Jd;ng------------------------------------------ El Distance to nearest lot line--------------------- ------•-----------------•--------------•---------- Remodeling and/or repairing (describe)-------------- ------------- -----------------------------•------------------------•----------------•--------•---------------------•- ----------------------------------- -------------------------------------•----------- --------------•----••--------------••------- -------• -------------•------------------------------•-----•------•---------------- -- 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 regul ion f the San Joaquin Local Health District. (Signed)--• r -------------- ----------- --------------------------------------------------------(Owner and/or Contractor] By:----------------------- ------------------ -----------------------------------------------------------------(Title)--------•------------------------------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USS ONLY APPLICATION ACCEPTED BY ---I--6-6------------------------------ DATE = ' REVIEWEDBY------------------------------------------------------------------- -- -- - --------------------------------------._._.- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- ------ DATE-------------------- -- -------------------- ----- -------------------------------•- ..._ --------------------------------- Alterations and/or and/or recommendations:----------------------=----------- -- --------- ---------•---•----------------•-------------------••-----•---- ---- -------------------------------------------------------------------------------•--••---------- ---------------------------------•---------------------•------------ ------------------------- ----- - - ------------------------=--------------- -------------------- ---------•.•--------------._....----------•------• ----------------------------------------- ------------------------------------------ -------------------------------------------• --------------------------------------------------- --------------------------------- -----------------------------------------------------------------------------.--------•....... -------- ....------------------ ---------- ._..._ �" ------------------ -------------------------------------- ---- FINAL INSPECTION BY:---- •'n �'► _ Date.- �- — i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 4 300 West Oak Street 132 Sycamore Street 814 north "C" Street - Stockton, California Lodi, California Manteca, California Tracy, California 4 E5-9-2M 145446 ATWOUD 12.54