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F APPLICATION FOR SANITATION PERMIT Permii (Complete in Duplicate) q/ y.-n Date Issued ---- --l_3f Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the herein described. This application is made in compliance with County Ordinance:No. 549_E_- JOB 49..E_-JOB ADDRESS AND LOCATION.-7D-O.-_- /C�G�+G C' Owners Name--- ,/f /v�c� - Address"_. _ Phone._..". ----------- - Contractor's Name.-- /9�X' !_S_.f/ .._..�'1'JC-.' - ------ Phone---------- Installation will serve: Residence E] Apartment House E] Commercial Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedroo'rris -------- Number of baths -_- "".- Lot size " "-" �.�- ' " Water Supply: Public system �ommunifi s stem �"` Y y ❑ � Private []��Depth to Water-Table _13,101_ {t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ Y ❑ y ❑ Adobe [D "—Hardpan ❑ Previous Application Made: Yes []�No [i�'New Construction: Yes [�No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank j.h� Distance from nearest well-_----------------Distance from foundation--------.------------Material-------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth--- I - ---------Capacity----------------° Disposal Field: Distance from nearest well__.--------------Distance from foundation-------..-.."- -...-Distance to nearest lot line--.----..__".." ❑ Number of lines-----------------------------------Length of each line.---------------_----------...Width of french----------------------------------- -of filter material-"""-__--.-____--_-"....Depth of filter mate�i'al--.----" ._-__-..Total length------------------------------------------- Seepage / Distance to nearest well.^4*v ---Distance from foundation-""16-----------Oris{ante to nearest lot line-_5-�""-_ Number of Pits---------1".---- Lining material--- -- Size: Diamet �� Depth ---� ----� (J esspoo: Distance from nearest well-----------------Distance from foundation__" " _ * . ""-""". ❑ Size: Diameter---------- ------------------ ----Depth-----•-- ----------- ... Lining material"-. "-""---_.-.".-__- --------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest well--------- ------�"--------.-.___------------- Distance from nearesf building-"-------,-______ ❑ Distance to nearest tot line--__-"."...."` , , ------------------------- Remodeling ------ _ Remodelin and/or re airin describe :_ -. -"G�dr � ��c3J N 9 p 9 ) ��' Y�i�j— /7�/ X / } ----•-------- - ----------•---I------------ _-....----•-------------- ""_-.""""-"".."----"""----------------------------••-"-_-•_-------__•.._--...-.--..-----_-•--------------------•----------._-_------_----------•.._-.-.------._-""_•_-"- ,-..------ I hereb ter+if that I have ! Y y prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, 5iatd-14ws, and rules and?egul�afioYns of the San Joaquin Local Health District. (Signed) ----r----- -------- �nTer and/or Cantractorj > ---------------------------- ---- 8Y: ---=------•- (Title] (Piot plan, showing size of lot, location of system in relafion to wells, buildings, etc.,,can be placed on reverse-'side)- I FOR DEPARTMENT USE ONLY \ APPLICATION ACCEPTED BY---- ------- ------- ----- ---- DATE---------- - - ----- -- ----------------------------- REVIEWED BY------- ------ ----- --------------------- DATE---------------BUILDING PERMIT ISSUED-------=------ -- ----------------------------------------- DATE Alferations-and/or recommendations:--------------------------- ----- ".-.---------.- _ - .•----------------- = --•- -•---- -------- , = •--------•--•--••- -----•-- ---•---•- -•------------- --------- ------ -------------- ----------------------------------------------------- f , FINAL INSPECTION BY:-_ Date---. SAN JOAQUIN LOCAE_HEALTH DISTRICT 130 South American Street '300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mantaca, California Tracy, California ES-g 145446 ATWOOD