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APPLICATION FOR SANITATION PERMIT Permit No. ._..!_ ._ (Complete in Duplicate) Date Issued a � Applicai-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, j JOB ADDRESS AND LOCATION...--__!_._- .-- -- ` ----------------------`------------- ---- -------------------------------- --- -------------- Owner's ----------Owner's Name-----0--- - -��-41Ai -- � ---------- ------ - ----------------------E-------- -- Phone-------------------I---------------- Address.-------- - ------•-------- --------- ---------------- Contractor's Name---- 1'---------I-----------lu------------------------------------- ------------ --------------------------------------- ---------- Phone-------------------I----------•---- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motpl ❑ Otheri ❑ Number of living units: ___/___ Number of bedrooms 2_._ Number of baths ___ Lot size _ __ �_ _ ------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe rdpan ❑ Previous Application Made: Yes ❑ No [( New Construction: Yes � No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted 'f public sBwer is available within 200 fee ��Materiai Septic Tank: Distance from nearest wel ---Dista�c fr�oryrym�fo tion_ __ ____ [ No. of compartments---------- ------------Size-= -- - d-x ____Liquid fdepth__-,.-- ------------Capacity_____- ---- Disposey�field: Distance from nearest wellASdPDistance from foundation ''"Distance to nearest lot ling . Number of lines----------- __.___ _.________Lang#h of each line---------- __��..._.Width of trench---_----2� �'� Type of filter materi .. Depth of filter material_____-� "---_----Total length___________ r14`� -l. vt Seepage Pit: Distance to nearest well_.---------------------Distance from foundation___________________Distance to nearest lot linen------__.____._ ❑ Number of pits---------------------Lining material----------------_------Size: Diameter----.------------------Depth----------------jIi---------------- W ' Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material--------------------h-_____.___ `! ❑ Size: Diameter---------------------- ----- - ------ Depth-------------------------------- - -------- - -_-Liquid Capacity-----------------1f--------gals. t Privy: Distance from nearest well____"____________________________________________Distance from nearest building____._____.__.__.______ I _______ ____ ❑ Distance to nearest lot lire.... -----------------------------------k--------------------------•---------------------------------------------- _n Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ --•----------...._.._..... I-----•-----•---- .n ---------• --------------`-----------------------------•------------------ --------•----------•------------I` i. ------------ ' -------------------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------, '--------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. jr--- ---- -------------- --Y=L .-------------------------------- -------------------------------------------------------{Owner and/or(Sign � - CI ntrectorJ 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 l REVIEWED BY .. - -- --- DA .....- - APPLICATION ACCEPTED BY 'ry -------------------------------------------------------- DATE�.--------------------------------- '== - -- -------------- TE. �-� ;j BUILDING PERMIT ISSUED ------------------------- ----------- ----------- DATE Alterations and/or recommendations:'--------- ° -------- ----- -----•----•- ------------------------------------------------..------- •�-....... . --- --- -- ---- --- -------- !l -- ------------- ` --------------------• --- - -- ----- ------ - ..� f`.. - ------------------------------------- FINAL INSPECTION BY:- R t^--------------------------------- Date.---- _ `� -------- - --------------- �I 4 SAN JOAQUIN LOCAL HEALTH DISTRICT -f30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 0 Stockton, California Lodi, California Manteca, California Tracy, California I-5--9-2M 345446 ATWOOD 17-64 I .