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_ APPLICATION FOR SANITATION PERMIT Permit No. .. . ... __...•f.__.. (Complete in Duplicate) Ur sI C Ia ' Date Issued -------/-------l---- 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. JOB ADDRESS AND LOC TION------- -/__�. .. �/ ------------------------------•---------------------------------•----- Owner's Name-----1�---------'�..--- ----- -------------------------- --------------------------------------- ---- Phone---------- •-- Address----=-----•----- "? . ---------------------------- Contractor's Name -1.. - ``-=` --•-----------•---------- Installation will serve: Residence a__xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + Number of living units: __/__._ Number of bedrooms __.�„ Number of baths __1____ Lot size ____._' _-_- -� ` Water Supply: Public system 10_ Community system [❑ Private ❑ Depth to Water Table [6- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 51 New Construction: Yes,,k No ❑ �y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q ' Septic Tank: ,P+s#ante from nearest well_________________Distance from foundation------------------- Material 11 ______--__-_______________.-._________.._____ ❑ i�7bf compartments--------------------------Size----------------- r�// ---------------Liquid depth--------------------------Capacity----- • -----------•- Disposa Field: i4stance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- El of lines-----------------------------------Length of each line------------------------------Width of trench----•---------------- = Type of filter material________________________Depth of filter material-__._________.__..._-Total length______._--_________--_______-_---______-_ Seepage Pit: Distance to nearesttance f�'founc"a ion__ Distance to nearest lot line___ Number of pits---------- ---------Lining material-- - - .,.« Di meter------- .: ___---Depth--- ------------------ Cesspool: Distance from nearest well-----------------Distance-from fo�undaf- n.-------------------Lining material ___-------__________________ -------- ❑ Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________--_--______•_____..__.____ ❑ Distance to nearest lot line----------------------------- Remodeling and/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 laws, and rules.gind regulations of the San Joaquin Local Health District. (Signed)-«u l c l+� •-•t. Y G' ''2 �� �-��---�--- ---• -----------------------------------------------(Owner and/or Contractor) gY: --------------------------------(Title)---- ------------•--------------•-------- (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 APPLICATION ACCEPTED BY DATE ---------------------------- -- -- --- ---- --- ----- ---- - ------------------••---- -- REVIEWEDBY---------------------------------------------- ---- -- ---- -------`-------------------------------------------- DATE-- :1.�--�-- -------••-•-- ...- -------.. BUILDING PERMIT ISSUED----------------------------------------- DATE•------- Alterations and/or recommendations:_ - ----- ------------------------- ---•--•------------------------------- --------- a ------- -------------------•---•---------------------------------- _� ---- ---- ---- ---- -------------- FINAL INSPECTION BY------------ = ��---------•------- Date-------4tp ----.1�.= . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54