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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) •3 !�� N Date Issued Applica}ion is hereby made to the San Joaquin Local HealthDistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan No. 549, s 'a JOB ADDRESS AND L CATI N F ------------- ---------------- -------------------------------------------- JOB Name__�P_ A �l Phone,.--,,--------------- Address---------'-`��- �j� � -----------------------/- -------••------------ Contractor's Name_____ V _Y ---- ------------------------ -------------------------------------------------------------- Phoned+!---T_2_c_l_�_ Installation will serve: Residence U6.--f+cpamtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units)r --/-- Number of bedrooms -7;k- Number of baths _1____ Lot size __________________________ I! Water Supply: Public system 21-Iommunity system ❑ Private ❑ Depth to Water TablesPo ft. Character of soil to a depth 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobear pan ❑ Previous Application Made: 'Yes ❑ Na1�evi-Construction: Yes El No Ef— -- TYPE�,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .4, ep ,T :, Distance from nearest well----------------Distance from foundation__.-___-_- ------Material-______.__._________...,�__�_ _� No. of compartments------ -- -------------- Size-------•------------------------Liquid depth-------------------------Capacity--------------------•-- Disposal�Fi ld: Distance;from nearest well---------------Distance from foundation--------------------Distance to nearest lot line.-...--------- Number of lines-----------------------------------Length of each line-------- ---------•::--_,_ ._.Width of trench----------------------------------- ....De0__L_ __r_f0 er I_____________ Type or filter matenal-----------�--------- --------Total length------------------------------------------ Seepage ----------------------------------------- See a e Pit: Distabnee:to nearest well --Dida ion_____ Q__�_.Distance to nearest lot line-----1_0 p 1 of pits------�'------__--.-Lining mat - Sze: Diameter--.�.!'--___-..Depth.-,?.�?"__°.__________- -...-Cesspool: Distance from nearest well_________________DidaEon----_...__.____.....Lining material__..__..._.._______.______.________. ❑ Size: Diameter---------------_-------- ----------Depth---------- -----------------------------------------Liquid Capacity----------------------------gals. iJ Privy: Distance'�from nearest well------------------------------------------------__Distance from nearest building----------.__-.______.________.__.___._._. [] Distancelto nearest lot line------._.::'_:.___._._. 11.. I Remodeling and/or repairing (describe)---------- ------------------- ------- '----------•--•---•---------------•- ------------------------•------------ - -• ------------------------------------- --------------I-________________________________4___ _______________________--.-_____--------------------------------------------------------------________-___--___---------------------I_-_--_-__________________________.__ ___________________________________________________________________________________________________________________________________ ----------------------------------____-----------II_-------------------------------_----------------------------------------------------------------------___------------------_------_-------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)---- ------ (GA-me. ra-dla Contractor) ----- ------------------ ----------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i�BY--------- ---------------------------------------- •---------- . DATE- -- ---------- ---------------------- REVIEWEDBY--•-------------------'----------------- ---------- --- -------------------------------------- DATE----------------''-- . �£�---+------------------------------------------------------------------ - . BUILDING PERMIT ISSUED.'i.. ------------- DATE. Alterations and/or recommendations:._.____.__.. .-. -- ' . � - - -- --------------1r ------ 0----- --------G-- -- :.. ------------------------ ------ IE FINALINSPECTION ------...-----• - ------------- Date-------- ----------------------------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street' 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9^2M 145446 ATWOOD 12-54 -