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APPLICATION FOR SANITATION PERMIT Permit No. -----271A. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to ops 'uct and ins 11 e work herein described. This application is made in compliance with County Ordinance No 549 I JOB ADDRESS AND 1_0 ,ATION---- ---- - ---------------- --- -------- - - -- -C Owner's - - -------------- one---.-------- ------- Address----------------------------------------- - ---------- ---------------- ------------------------------------------------------------------------------------------------- Contractor's Name--.i r -------------- -- ------- —------------------------------------------- Phone...soe!�_�--- Instailaflon will serve: Residence 09--Apartment House F] Commercial [] Trailer Court E] Motel E] Other E] Number of living units- f ----- Number of bedrooms Number of baths __/__ Lot' size __-----_---__-.__.---_ Water Supply: Public system E] Community system Z Private [-] Depth to Water'Table it. Character of soil to a depth of 3 feet:. Sand [j GravelE] Sandy Loam o Clay Loam E] Clay [] Adobe Hardpan E] Previous Application Made: Yes.[:] No,� New Construction Yes Kif No E] 4 TYPE OF INSTALLATION AND SPECIFICATIONS: VI (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well '4'____Distance from foundation_/ ............Material-_<Z_& ------------------- No. of compartments-__2------------------Size__-25*Z_/ -C----Liquid dep.th----- C).� ---- Disposal Field: Distance from nearest Distance from foundation Distance f6`,nearest lot fine,__-�20 Number of'lines--- Length of each line_------;;�7 Width of tre,row___1_524/=------------------ or ___R__Depfh of filter material__-__'j_g ,Type T filter mafer;aI__1.a.. ---------Total length........ -—------------------------- Seepage Pit: Distance f07 nearest ---.-Distance from fouadafion.......? ._/-..Distance to nearest lot line----4��F 10- Number of pits--------/-----------Lining material_e4�---- ....�ze: Diameter___':�.,S -ev ---Depth-- ----------------- -t_ i, Cesspool: Distance from nearest well-----------------Distance rf rom.foundation................... Lining Size: Diameter-------------------=I .. . material--___._---_,_________----__----_-- F1 ......-..Depth------------- --------------- -------- -------------Liquid Capacity-------- ----------- .. - -------- --- ....gals. tr Privy- Distance from nearest well_,--:-_ _ z-----------------'- ----------Distance fromnearest building------------------------------------------ 1-11 Disfance'to nearest lot I;ne,- :1!�E : --------------------------------------------------------------------------- Remodeling and/or repairing (clescrib6):-- -------------------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ---------I------------------I-------------------------------------------------------- ---------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------- -------------------------------------------•---------__---.»...-------..».._------------------------------------_-------------------------------------,----.-.------_------•-------•-••-------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S"fe �ws, and rules and regulations of the San Joaquin Local Health District. (Signed ... .. ... ---- ---�_ ------------------------------------------- ---------------------low r and/or Contractor) ------------ By:- ----------------------(Title)_ --------------------- (Plot plan, showing sizL of lot, locatiden, —,ys;em in relation to wells, buildings, etc., can 6 1 e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE - -------------------------------- ------------------------�c�------------- -- --------------------------------------- --------- --->___12r"- --------- --DATE-------- REVIEWED BY------------------------------------------------ ------------------------------------------------------ ------------- 'k�l---------------------------------- BUILDING PERMIT ISSUED-----_-_-------- 1r,- -- ---------------------------------------------------- DATE. ----a------------------------------- -- - ---- ----- ------------ ------- , Alterations and/or recommendations:------------------- .... ---------------- --------------------------------------------------------------------------- ...Tr_------------------- _�c --------------------------- ------------------------ ------------.-- ---------------------------------------------------------- ............................ S, ------ ------------- --- -------`' �--------4-k-1- 4---------- ----- --------- --------- ---------------------------------•-•------------------------------------------------- -------------------------------------------------------------------I—-------------- -------------------------------------------- ------------------------------------------------------------------------ 4_ .............•-•-•-•-•--. ------------------------------------------ ---------------------------------------- ---- --- --------------------------------------------------------------------------- -------------------- FINAL INSPECTION BY:------ ------------------------------ Date------- -------------_-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54