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APPLICATION FOR 'SANITATION PERMIT Permit No. ___------------_--.-.- (Complete in Duplicate) S 0 Date Issued _��.-- + Joaquin Local Health District for permit to c �truct and install the work herein described. Applrca ion is hereby made to the San Joaq p t This application is made in compliance with Count Ordinance No. 549. JOB ADORES D L ATION. - ---------------- t -- - -- -- - -------- - --- ------- -------------------------------- Phone------------------------------------ --- Name----- -•------- ----- --- --- ----------- - --- Address.&' Name =' --- ----- ---- ----------- --- ----------------------•----------------------...-----•---------------------------------- Contract --- ----------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ the ❑ Number of living units: _1_____ Number of bedrooms -2__ Number o aths .__ _._ Lot size _SG/__ _�- .-- __.._______________ ____ Water Supply: Public system ❑ Community system ❑ Private Depth t Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee .) ''`� • " Septic ank: Distance from nearest well__�}70 __Dista fOT-0euc ation ._______________No. of compartments-------:- 1 -�----.Siz k- Liquid��}}�ef�?�th�, '7" Capacity Q r Disposa ield: Distance from nearest well-- .._Distance from foundation_W(,!__�Fn^''_tUistance to nearest let I' �___ ------- Disposa ield: Distance from nearest well-- ....Distance from foundation W� 'istance to nearest I f I' Number of fines___ _____-_____Length of each hne_jWC_L Width of trench______�-V_ _______________ e th of filter material_.-.-----1.45-11...Total length------------ > --�____-_____-__-_ Type of filter materi �D' p -- Seepage Pit: Distance to nearest well______________ _______Distance from foundation---____-------------Distance to nearest lot line-----_-_________- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----._--------------------------- 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-------- -------------------------------------•---•--------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)------------------- ------------- --- ---------------------------------------------------------- -----------•-------------------•---- ------------------- ---------------------- --------------------------------•----------------•----------------•------------------------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. 17, (Signed ' ^ _ --- ---------------- ----------------------•--------------------------------------------- --(Owner and/or Contractor) ------ --- - � Vit - BY: - --- -��-r- --- --------------------------------------- {Ti+le) - ------------------------- - (Plot plan. showing s' of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY( -- ----------------------------------------------------------- DATE ._ ----------------------------------------------- REVIEWEDBY - DATE-- --------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------- -------------------------- --------- DATE-----V..------------------------------------------------- Alteration4 and/or recommendations------------------------------------------------------ -- --------------------- --I- ---- --1-- -------- ----I- -------- ---- ------ -- --- --- --- -- ---0 -- --- -- -- _- -- --------- -------------- ----------- --------------------------------------------------------- ------- - . ----- ---------- --• ------------------------------------------------------- FINALINSPECTION BY:------------------------------------------ ........ ------------ Date------------ --------------------------------------------------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 1Z-54