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1 = APPLICATION FOR SANITATION PERMIT Permit No. .-'7.`?. ._-.. (Complete in Duplicate) Date Issued ---- -------._._---J Appliceion 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. 549-1 ' � A .4 � JOB ADDRESS Al LOCATION.. F-'_ `----�` ° ±...rte , Owner's 'Name------ L. - 1k'.-i; -► - ,/ -------' Phone = .rY Address 1. l---------- --•--- � V ............................ 6�) t d Contractor's Name--- •-------------------------•-------- `-------------------- -------------------------•----------------------''- Phone-------------------------------- Installation ---••---------------------- •-Installation will serve: Residence.El""O'Apartment House]❑ Commercial ❑ Trailer Court ❑ Mot ❑ Other ❑ x Number of living units: J---- Number of bedrooms--- . Number of baths �_----- Lot size ---------- --- - _--_--_-_----___ Water Supply: Public syste .M/Community system F-1 Private" �epth to Water Table __--r._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan [] v1 ` Previous Application Made: Yes ❑ Na New Con14 truction: Yes DT'No ❑ �! r TYPE OF rINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance #rem nearest well-----------------Dista ce from foundation--- a ' 1 , P� S Ma rial �. No' of compartments..- ---_-- •--_-,_-_ th Size-� � Liquid d p, --- ------------Capacity-- 0-0 Disposal Field: Distance-.from rieare'st well.' '. /& ' _.- .-----Distance from foundation.. ........ ........Distance to nearest lot lmaa--...---__... ® Number of lines---------- ---._ �----------Length of each line------------ Width of trench------------- - -------_- T e of filter materia _� I_- f F Type , - .�t ` Depth of filter material___---�- _. --------Total length-__------ -, A_ _________________•- G i Seepage Pit: Distance to nearest well-------------------_Distance from foundation-------------- -.-_.Distance to nearest lot line----------------- ' El ------------_._ • ❑ Number of pitsi--------------------Lining material-----------------------Size: Diameter-----------------------Depth..---------------------------_„- ` Cesspool: Distance frog nearest well-----------------Distance from foundation--------._-.--.--- Lining material-------------- ----------------------- El -..-__----.- _-_--_.__----.--_,_-. ❑ Size: Diameter--'---------- ----=------- ------Depth--------------- ----Li Liquid Capacity -- -- ------- ------- - � 9 -----------------------------gals. Privy: Distance from nearest well-------------------_- 4 ________------___ _________Distance from nearest building-=__-_._----._-__----- ❑ Distance to nearest lot line-----------------------------•----------_--------- 'Remodeji g and/or repairing. describe] �� ----•-------------------------- ----------------•-------•--•------- --••----•----�_�`--- ------------ - ----------------------------•----•--- ------- � ._ ' -------------------------------- ------------------ •------------ __ .. ..7Al _ r ----- --------------------------- -- ---- •--- = I;hereby certify that 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. t (Signed]_._.. r ]= = - ------------------ ---------------------------•-----------------'-- (Owner and/or Contractor), By------------------------------------ •------------------------------.---------------------...----------------------------------=--(Title) �` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can-be placed on reverse side). \, x } 4a , I FOR DEPARTMENT USE ONLY APPLICATION"ACCEPTED BY_ _�T _-________- DATE-�-_- .-- ------------- ----------- ------------------•--- t= REVIEWEDiiY------`---------- ------ ---------------=-:------------------- -------------------------------------------- DATE___q DATE--_ ___ BUILDING PERMIT ISSUED _ --•--•-•`-----=-----•--------------------------------- ----------- ---------------------------------- Alterations and/or recommendations;: . ------------------.------------ i--*--,-* -` `� t ---------------------------------------------------------------L--------------------- ------ ----••------------•--•-----------•-------------••-------•-----------•----- --------------------------•-----------------------------• ------------------------------•-------------------------••-•-----------------------------------•-•-•-----.---------------------•-- ------------------------------------- ------------------ -------------------- -------- -------- - FINAL INSPECTION � == 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 145446 ATWOOD