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t4y APPLICATION FOR SANITATION PERMIT Permit No. __..7.cJ............ ° - (Complete in Duplicate) Date Issued ___- _______________ Appliceion 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. *_/_71 f Crfi-trrJ ?� JOB ADDRESS AND LOCAION_�_- - -z �" `- ..0RA Owner's Name__._____ r ----- -------- Phone. Address--------- --- -•-----�-- - -yam- �-- �-- ��__f..-•-----------C • Contractor's Name ---------------- ------------ Phone-----•• Y Installation will serve: Residence Apartment House Commercial �_ ❑ ❑ Trailer Court 0 Motel Other Number of living units: _ --- Number of bedrooms .-2_ -umber of baths ---/... Lot size ------/ .-- �- Water Supply: Public system ❑ 'Community system ❑ Privatejg-_Depth to Water Table dy!_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ NojjZ _-New Construction: Yes RL_No n- TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet. r Septic Tank: Distance from nearest well_k' ---__Distance from foundation____ 'No. of compartments____ ----- _ Size_____ xLiquid depth .__Z _ ----.-Ca acit2a—d Y ------ Disposal Field: Distance from nearest well Distance from foundation___ -- - ------- Distance to nearest !o} line__ Number of lines---.------.`---._._ �� Length of each line______ __. . < �- ---. Width of trench . Type of filter materiail_�..__ epth of filter material------lg-_ ------Total length-:----- Seepage Pit: Distance to nearest well___ . ---_---Distance from foundation___- _._.Distance to nearest lot line____�Q_f- .� _ Number of pits---.____-----------Lining material--e Diameter____. �r ' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------ ❑ Size: Diameter---- --------------- ----------------Depth----------------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______ -- ------------------_________ -----------Distance from nearest building ' - El 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 d rules and regulations of the San Joaquin Local Health District, (Signed)______________ ;i,ii `�L -- --- - - ---------- ----------------------------------- --------- (O nor and/or Contractor) BY: = - - - ----- .[7itle) (Plof 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 ---- -- -------- DAT -------------------------------------------------- REVIEWED BY ---------- - --------- bATE__2's -------------------------------------------------- BUILD1NG PERMIT ISSUED-------- - _.: ------------------- ------------------------------------------------ DATE-- - --------- ----------------------------------------- Alterations and/or recommendations:.-..___.__.._____.____ -. -------------•----------------------------•-------•-•--------------------------•-----------------------------•-•----••----------------••----•-----••---------- - ----------------------•-----•--------•---------- ------------- ------------- --------------------- �.- - r -- , ------------------------------------ . -- FINAL INSPECTION BY: `- `' vv-----------_--•--------------- Date--------- 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 En-9 149446 ATWOOD