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1r� 5 4 �:g_ �0 ..__....!' 1� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued �.�'�_�_ � O 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. L T fi . JOB ADDRESS AND LOC TION---1---/7 r.- ----------- S- Owner's Name.---6- �-- ......... -^*AIV- -�--------------------------- ---- ---- ------------- ------------------------------ Phone------------------------------------- Address----l --- ---e----••-- - .....-------------------•-I---------------------....------------------------------------------------------.---------- Contractor's Name-----Spo -------------------------- ----------------- Phone------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ }-_ Lot size _ Number of living units: _-!-___ Number of bedrooms _7--- Number of baths -L! �----1 --- Water Supply: Public system 9?1<ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑I Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 1EK_Zk_,44" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- --------------Distance from foundation__.____-_____.____.Material-_____..._______--__-_---.--_.--.-__---______-- ❑ No. of compartments---------------"----------Size------- -----Liquid depth.-------------------------Capacity----------------------= Disposal Field: Distance from nearest well ................Distance from foundation--------------------Distance to nearest lot line__--____-________ ❑ Number of lines-----------------------------------Length of each line-----------.----_.------------Width of trench----------------------------_--.--• \ Type of filter material-----------------------._Depth of filter material-----------------._.__.Total length------------------------------------------ _______Distance from foundation____________________Distance to nearest , lot line_.___-_._--___. " Seepage Pit: Distance to nearest well_______________ �. 0� ❑ Number of pits----------------. Liming material--------•--------------Size: Diameter----------.............Depth__.__________..___-__ __--- Cesspool: D•++stance from nearest well--------------___Distance from foundation-------------------.Lining material__._ ❑ Size: Diameter----- ------------------- -------Depth--------------------------------------------"-------Liquid Capacity----------------------------gals". i• f`�� Privy: Distance from nearest vrell--------------�;---------------------------__-_Distance from nearest buildin g Distance to nearest lot lin -- /o -- ... - --------------------------- -- ----- ---------------- " -es ribe):Remodeling and/or repairin �- -----�'---- .._. .. ---------- A - - _ � ------------------ -.�„ — I hereby certify that I have prepared this plication and thy} 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. r (Si ne ----------- ______Owner and/or Contractor } y:-- --------- -- ---•:'•,. build t Ian showing size of"lo+, location of system in relation to wells., lg-�j--------------- �----- -----{Title)-------------------------------------------------------------=--- ; B . (Plot p g ' `'- a+c.,,can be placed on reverse side). f FOR DEPARTMENT USE ONLY — DATE------ ----------- --------------- i APPLICATION ACCEPTED BY----------------------------------- - REVIEWED BY------------------------- DATE- r '-------------------------"-- V BUILDING PERMIT ISSUED-------------------------------- ----------•---- ------------------------ DATE----�---- ----- Alterations and/or recommendations:- -------- - - ---------------------"--------------------- ------------------------------------------------------------------------------------------..._ ---- ------------------------ -------------------------------- --------- -------T FINAL INSPECTION BY. 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 ES-9 145446 ATWOOD