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r r APPLICATION FOR- SANITATION PERMIT Permit No- ------------------------- (Complete in Duplicate) q d Dafe.ls.ued Applica-%n 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 Ord' nce No. 549. JOB ADDRESS AND LOyCATfON.`__�„7---`� �. Owner's Name--------- �? f"'- _�,�' � •--•---------------------------------------• Phone- {} ------------------•---- r Contractor's Name-------- - ` Au 4" r -------- r - yes -- -- -- ------ - -------- - ------- -------•-------- Phone-----•--•------••------•- Installation will serve: Residence D-i partment House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other ❑ Number of living units: _�_-_ Number of bedrooms � Number of baths --/_-_ Lot size - ` Water Supply: Public system ��-�-�'(�----`--------•--- PP Y� -------- Y Community system ❑ Private ❑ Depth to Water Table ��t.� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe L2,�- Previous Application Made: Yes f Hardpan ❑ No �' New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f j � �- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well r � --4'Disfanc f om foundation---.- - _ ' f fv Material ] ---- No. of compartments - 5ize-- ----- - .p -Li Liquid de th F • - yrs:.; .a - q R 4- ---- --------Capacity- --�4-P------- Disposal Field: Distance from nearest well_- �,C 'Distance from foundati n--/9-�- ,,4� ----..Distance to nearest lot line-- ____--_•- Number of lines________ ___ ____________ __ _ engfih of each line---_L10�-f t� Type of filter material/� p Width of french------ ---_ 1 De th of filter maferial._-- ......Total length--------7!t:��_Ie Seepage Pit: Distance to nearesf well--__ ;t,_Distance from 17 aon tion-._ �_-..._ Distance to nearest lot line--- ------------ ----- [ Number of pifs-- �____--------Lining material,��•(� Size: Diameter--- ___-----Depth_--- Cesspool: Distance from nearest well---------------_-Distance from foundation----------------- Lining material- ------------- ---------------- ------------------------- --------------- V� ❑ 5ize: Diameter-- ------------------------ Depth ------•--------•- - - - - -- -- --------------Liquid Capacity-.-.--------•-------a-------gals. Privy: Distance from nearest well------___-----°- _-----_ __------_Distance from nearest buildingW ---------- ❑ Distance fo nearest lot line--------- ------------------ *,e Remodeling and/or repairing (describe):------ ---- ---- ---- -- - •--- ---------------------------•- ------ -- -• -----• ----- y 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 andf regulations of th�Sn oaquinLocal Health District. (Signed)..----- . ---------•--- - n----------- L % Contractor) ----------•----------------- ---- BY:-------•----------••----------•----------------- t��-=---- -=---/-�--� .�------------------ •---------- ..--------(Title)----�'-`%�f� '-` - -- {Plot plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed o1n reverse4de}. FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY____________________ DATE-.- - - -- REVIEWED BY ----•----- - --------------------------------- BUILDING ---- -------- -----------------BUILDING PERMIT ISSUED............. - ----------- ------------------------------------------------ DATE-------------- -------- -- - - ----------- --- DATE Alterations and/or recommendations:----_---_ ----------------------- ---------•-------•--- --- --- . --•---- ---- - --- --- -------- ----- - •---- -------- -= ------- ----- -------------------------- ------------------ FINAL ---------- FINAL INSPECTION BY:____._-____--_5-------_TM-- ----------•------ Dete--l-1?- fo. -cS --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street " Stockton, California 814 North C" Street Lodi, California Manteca, California Tracy, California ta-9 145446 ATWOOD