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APPLICATION FOR! -ANITATION PERMIT Permit No. ...Q.- (Complete in Duplicate) Date Issued4 Applica'ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549. 1, JOB ADDRESS AND LOCATION---- �'--- � --p�''--�-°' �'--------------------------- --------------------------------------- ----------- Irl } s.r '-i- --------------------------- --------- Phone '- Owner's Name.....________-_ Address........ --' ---1 I;_._ ..._.. •- i -•------------••----------- -------------------------------------------------------------- ----•-----..-- -----•----------- ••- Contractor's Nam ------ Phone - Installation will serve: Residence u Apartment House ❑ Commercial ❑ Trailer Court ❑ otel [3 Other ❑ Number of living units: ---I--- Number of bedrooms __1----s;Number o aths ---i... Lot size _ 4_......._�1 �_______"______________"-_ Water'Supply: Public system F-1Communitysystem ❑ , Priate Depth to Water Table ______ ft. Character of soil to a depth of 3 feet: Sand ° Gravel El Sandy Loam E] Clay Loam C] Clay (I Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes P"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �! ii (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) I � Septic T nk: Distance from nearest well----------------"Distance from foundation.................... No. of compartments------------- - ---------------------------Liquid depth--------------------------Capacity-------- ------ I ' Disposa�ld: Distance from nearest well.................Distance from foundation----------.------.--.Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line----------..------------------Width of french----------------------------------- Type of filter material __....._-___4__,------Depth'of filter material----------------------Total length"_"__"_""_______.....----------.__--_.__-- Seepag Pit. Distance to nearest well._)--------------Distance fro foundation-.�l 'itf-Distawe to nearest lot Ijye__- -__.-_.-_ [ Number of pits._____(--------------Lining 'Mate rial__ r-` ----...:Size: Diameter__ 0-_-__._.__Depth-----` "�_--_-._-__-__-_-_--__ -.Cesspool: Distance from nearest well------------------Distance from foundation-------------------- Lining material_______________________________-_. ❑ Size: Diameter---------------------------------- V Depth ---------------- Liquid Capacity-.-----------------------•-•gals. Privy: Distance from nearest well------------------------ i�--------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lotline----------5----�--4--------;-----------------= -------------------------- ------ ------------•------------- ,---------------------------------------------------------------------- Remodeling and/or'repairing (describe):--.-_-_--. -"----- -= '---------- --------------------------------------------------I ----------•------ `1--------------'--'-------------- - I hereby certify that I haveprepared this application and'.4hat the work willrbe-done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) oj�d -- ---------------------- ---------------- --;,--- - ----------(Owner and/or Contractor) BY:---------- ------ '----•- 1 --"-=---- $-----==•-- ------------------------------ (Title) (Plot plan, showing size of It, location of system in relation to:wells, buildings, etc., can be placed on r erse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------- ---------------- DATE----- - - r REVIEWEDBY-------------------------- ------=--- -------- ------------- '""' DATE •-------- ----- -•--- BUILDING PERMIT ISSUED--------...'._..------ ----------- ---- - DATE." " - AI ra i sand/p r re omm ati � - ------- �-•--- ------------------------------------- L ------------------------------ L E; ------------------------------------- ------------------------------ ----------------------- ---•---------- - . -- - ------- ---------- --------------------- ---------- - jFINAL INSPECTION BY:-.I- ---- - -- _ �' Date /`.c a SAN JOAQUIN LOCAL HEALTH DISTRICT J 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ! Stockton, California Lodi, California if Manteca, California Tracy, California r ES-4 145446 ATWOOD