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:I 11 APPLICATION FOR SANITATION PERMIT Permit No. :t (Complete in Duplicated Da; /i!r /s �I te issued --•- -_-/--- ---- ---� - Y. Appliceion'is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appkication is made in compliance with County Ordinance No, 549, JOB ADDRESS AND CATION----- -- - --- -- �— 0 ! g = Owner's Name 67-_-___A/ +� 't -------••-•----- --------------- -- - --------------------------------------- Phone-------------- -------------------- en Address.------.. l ------ -- -----------------------------------------•--------•---------------------------------------- - k Contractor's Name - --•. .... Phone---------------------------------- Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ otel4_ Other ❑ Number of living units:.___ Number of bedrooms --- 'Number of baths /_---- Lot size -----------'/_-4 / i ___._-___--_-- Water Supply: Public system M._�ommunity system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] F4 Clay ❑ Adobe ardpan E]Previous Application Made: Yes El No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: x (No septic tank or cesspool permitted if public sewer is availablewithin 200 fee/t.) Septic T Distance from nearest wellp_Dista a ro f undation__.1-a__._- aterial------�__----.- �p 1 No, of compartments_._.__ ' -_______.__Size.___( _Liquid dopa -J______________---_-.Capacity.-71:._ Dis sa ield: Distance from nearest welf-AI -Distance from foundation _____ _________Distance to nearest lot lin per- i f Number of lines_______ ______ ______ ____.Length of each line______ ___. rf_._.Width of trench._-_ -�--�. SeepagePit: Distance tloonearestriwlell...--__- Depth of filter material___ Total length r ..................... ___Distance from foundation--------------- ___Distance to nearest lot line-._______---_.__ ❑ ' Number of pits----------------------Lining material-----------------------Size: Diameter----------- ------Depth---------------------------------- Cesspool: ---------- -_.Cesspool: Distance'from nearest well-----------------Distance from foundation----.---------------Lining material--_--.___--_.__---.___.-__-_-__-_-_. ❑ Size: Diameter------------------- ------.----------.Depth---------------------------- -----------------Liquid Capacity---------------------------gals. �. Privy: from nearest well-----------------------------_--- _....______-Distance from nearest building------------------------------------------ ❑ Distance.fo nearest lot line------------------------------------------------•-----------------------------------------------------------------------------------------. Remodeling and/or repairing` (describe)------ ------------------- --•--------- -- -----___------------------------------------------------------- ---------•----------------------•- - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------••------------------------------------------------------------------------------------------•-••----------------•-------------------------------•----=----------------- I hereby certify that 1 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 WSanJoui�Lo I Health District. (Signed) ------------------------------------------------------- ----{Owner and/or Contractor)' By:-------------------------------------------------------:-------•--- ----------------------------------------------------------------(Title)---- •--- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i } FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY---- ------------- --- --- -- ---------------------------------------- DATE----- - . r - REVIEWED BY --- -------------------- DATE BUILDING PERMIT ISSUED--- - -- _ -- -- +++��!!! ---------- ------- --------------•- ----• --------- DATE_----•�-�--....._�------------------------------------- Alterations -- ------ ------------------------ Alterations and/or recommendations------------------- -- -- '� .:_,_-.---•-•------------------------- - --------.-------------•------------------- -------------------------------•--------------------•---------•------------------------------------- ------------•- =Y=----------------------------------•---•---•-----------------------•------------•------------------ " --------------------------------------- ----•---------------------------- ------------------- -I- ------ -- •-------------------------------------------- -------------------------- ....................... FINAL- INSPECTION BY:_." yl � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9 :45446 ATWOOD d