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S 7.k3 APPLICATION FOR SANITATION PERMIT Permit No. ..... �d..�- (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 County Ordinance No. 549, JOB ADDRESS AND LO TI/ON� __... �------ --- ----------•---------------------------------------------�-- } Owner's Name --------- -----� --------------•--- ----- ------------------------------------------ - Phone,/ __4 Address.... Contractor's Name-----------------••----..._� ------ r--------------------------------------------------------------- Phone/*' 46`1` 7- ------------ Installation will serve: Residence// Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other Number of living units: -!-____ Number of bedrooms .-3_ Number of baths I____ Lot size __JA4_'X_/9�____1---------_------------ Water Supply: Public system R Community system ❑ Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[R-11ardpan ❑ Previous Application Made: Yes ❑ No R--'-New Construction: Yes ❑ No ®-'. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_________________Disfance from foundation__.________..f------Material__.C,e.- No. of compartments---------oZ-----------Size---'S l_F'--- ...Liquid depth.-.--�P-a--��----------Capacity--�d------ Disposal Field: Distance from nearest weal Distance from foundation---y4__------Distance to nearest lot line-____.____ $... [� Number of lines-------- Length of each line________- _�__--------Width of french----•Z_y---- __.._______.___ Type of filter material_$'c_l de� Depth of filter material....-_ l.....___..Total length---------?SC_-__ _ __________ r � Seepage if: Distance to nearest//well_ Distance from fou dation__._G_�__..___..Distan��fo nearest I t-i'nt _' _-__- Number of pits------[.._._________Lining material__('-Size: Diameter-----,�.5_..____..Depth__.(� 4 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----------.--------------------._----_._. ❑ Distance to nearest lot line---------------------------- ------------------------------------------------------------------------------------ *� Remodeling and/or repairing fdescribe):--------- ---------------------------------------------------------------.-------------------•-----------------------------------------•----------------- U --•.............•-----•--------------------------------------•---------------- ------------------------------------ --------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- --------------------------• ------------------•------•------------------------------------••-------•-------------------------•---------•---------------------------------•-------------•------------------ --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ -----•-•--------- /------------------- ;------------- ------- ---------------------------- ------ Owner and/or Contractor) a BY:----------------------------------------------------� -----------------------(Title)-- -- ---- -�---------------------------- -- - ------------ (Plot plan, showing size of lot, location of system in relation to Wills, 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 recommen atio s--------------- -- ----- ------------------- 9N.r F - ----------------- - ,.c , - ---------------- ------ ----------------------------------------------- -- ------ FINAL INSPECTION BY:--- ----------------------- - ------------ Date----- --�---��------- ��-- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California -9 145446 ATWOOD