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Q.� � Permit No ----- -- --- ------ ° APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Is-sued �1 Applicakion 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. 49. JOB ADDRESS AND LOCATION___! ---- •---------- Phone----------- ---------------------- ---•---- Address------------ `..- ------ -- Phone ............. Contractor's Name---------------------- --------•------ -••-------- ------- -- Installation will serve: Residence [ artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms ---2- Number of baths I----- Lot size ..--�.l-O-o--------------- Water Supply: Public system Community system El Private ❑ Depth to Water Table ' L- ft. ravel Sand Loam ❑ Clay.Loam ❑ Clay ❑ Adobe ar pan ❑ G Character of soil to a depth of 3 feet: Sand ❑ ❑ Y Previous Application Made: Yes ❑ No Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 f Ir f Septi Task: Distance from nearest we14_ _------__. Distance from foundation__________eet.)----------Material------------------------------------------------- No. of compartments------------------- -----5'sze---'----------------------- ----- Liquid depth--------------- - --------Capacity----------------------- isposal apace Y----------------------- isposal 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------------------------------------------ Type --.----------------------------- ------- D'sstance f m fo ndation__.__f Q.�----.Distance to nearest lot line___---...... Seepage Pit: Distance to nearest well_ + '.-- ,� Number of pits----- ----------- --Lining material---. -------.--------Size: Diameter___23_---------Depth_" .----------------------• Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---_'.-_----------------------------- 171 . Size: Diameter--------------------- Depth -.-Liquid Capacity -gals. Privy: Distance from nearest well----------------------------- -------------------Distance from nearest building------------------------------------- El Distance to nearest lot line---------..................... ------ ----- -------------------------------- Remodeling and/or repairing (describe --=--------------- ---------• ---- --- . . ---------- ---•----•-------•------•-------------------••---- -----------------••----------------•-------------------------------•---------------------------- I hereby certify that I 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 San Joaquin Local Health District. y -------------------------------------------•- owm7w br Contractor( Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _---------------- ---------------------------- -----------•--------------- DATE.......... --•--•------- --------------------------------- - DATE.--- ----�---�---•---...-----------...----------- REVIEWED BY------------------------------------ ---------------- - --- - - - � ------ - ---- -- - ----------------------- --------- DATE-------------- BUILDINGPERMIT ISSUED----------------- -------------------- •--- ---- --------------------- Alterations and/or recommendations--------------------- --- ------ --------- --•------•---•------ -----------•- ---------------- { -on ------------------------------•-----•----- --------------• --------------- ----••----- --------- ----- - - - - - ------------------------------------ ----------- ----------- FINAL INSPECTION BY::............ ... . - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tree California Stockton, California Lodi, California Manteca, California y E5-9-7M 145446 ATWOOD 13.54