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APPLICATION FOR SANITATION PERMIT Permit No. _---- l (Complete in Duplicate) Date Issued 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 CountyrOrdinance No. 549. JOB ADDRESS 4ND ,60CATION'_�- � . Owner's Name '.f '''-ry ----------------- --------- - Phone-------------- - --- ---- ----- ------------------------- Address-------- - t ----•-----j--------------------•---------------- Contractor's Name--- _-._ 14A • ----------•--------- - Phone Installation will serve: Residence [j]: Apartment House ❑ Commercial [-ITrailerCourt [3 Motel E] Other ❑ Number of living units: ._.!-_ Number of bedrooms -;4-- Number of baths __ �}� - Lot size ---- _ - _ _�l ------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam 0 Clay Loam E] Clay [_1Adobe =. Hardpan ❑ Previous Application Made: Yes I-] No l-7 New Construction: Yes 4[ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if. blit sewer is available within 200 fee .] SepticIFank: Distance from nearest well-- �F- w _Distar� frory fa dation/f,�_�`�"'.`'Materik "_ No. of compartments ----- p .Size _ _._Liquid depth �� Capacity Dispos�I�Field: Distance from nearest II- ? J Distante from foundation-��_�istance to nearest 11 t Ii e 0 Number of lines__________________e ►- �- -- -_- .Length of each line___ _ -... ]�,.Wid+h of trench_____•�.�-�-_� �,s� -. Type of filter materia# .t "-- -Depth of filter material-__-- _- .-+--__.__Total length----- _ ---_ - )-- ------------ Seepage; Pit: Distance to nearest well----------------------Distance from foundation--...___-----•__-__.Distance to nearest lot fine El Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth-------------------------- esspool: Distance from nearest well-----------------Distance from foundation.-._- ------------.Lining material--_.--._.-_----__---___ ___. \ ❑ Size: Diameter---------------------------_ --.Depth-------------- ------------- -------------- --------Liquid Capacity----------------- __________ •--gals. - Privy: Distance from nearest well-------------___-__-_-__--__-_-_------:__..-_Distance from nearest building ❑ Distance to nearest lot line__-------------_-------------------------------- Remodeling and/or repairing (describe):-____- __.__.__--.-- ------------------------------------ ----------•---------•-----•--------•----------•---•---------- 1 hereby certify +hat ! have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, ant( rules and regulations of the San Joaquin Local Health District. `,�C l� -- ------- - ---------- ------------- ---------------------------- --------------- ------------- -- -------(Owner and/or Contractor] By:------------------------------------------------------------------- Title ----------------------------------------------------- Pot plan, showing size of lot, location of system in rela+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----------- DATE.^..,-------------------------------------•--------------- REVIEWED BY ------------------ - DATE ..----- BUILDING PERMIT ISSUED-------------- -_________ - --------------------------------------------- ---------------- -------- ----------- -------------------------------------- ---------------------------- DATE-.- Alterations and/or recommendations________ -------- ------------------------------------------------ •--------------------------------- -------- - ,��? j FINAL INSPECTION BY: "v--" --------------------------- -------•-- --- Date...._-__�-{ �N SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-S4