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'IV .40 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ----1/' Applica+ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance, City Ordinance No, 549. ------------- JOB ADDRESS AND�OCATION.._Aec �........ --------- ------------- 7-1 ------------------ .... ------------- Owner's Name -- - - - - -- - -- ------------------------------ ------------- Phone----------------------- Address--------- --------------------------- ------- Contractor's Name-------- ...... Phone----------------------------------- A---,__�t ----- Installation will serve: Residence P4- Apartment House 0 Commercial ❑ Trailer Court C] Motel E] Other 0 Number of living units: _/---- Number of bedrooms Number of baths _/__ Lot size ------------------------ Water Supply: Public system F .5 IT. I Community system El Private JE- bepfh to Wafer Table Character of soil to a depth of 3 feet: Sand E] Gravel E) Sandy Loam E] Clay Loam L] Clay F] Adobe Rq--Frardpan ❑ Previous Application Made: Yes EP-<o El New Construction: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ep t it'T,9 n k: Distance from nearest well-----------------Distance from foundation---------------.-_Material----------------------------_----------------- No. of compartments ------ - ----------Size--------------------------------Liquid depth--------------- ----------Capacity----------------------- Di ---------Capacity----------------------- Di salt Field Distance from nearest welt-- -Distance-Distance from founclafion--.1-14-------7-------Distance to nearest)pf line_________________ dr Number of lines---__4---- --- -------/,�_Length of each line___-- - ---- -- Width of trench---4�-----------y- -------- Type of filter mafe6al__/1-A1/k"_Depth of filter material---- .__.__._Total length_______________-7? 7--------------- A -Seep �e, Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line___-__..___-_-.__ Q4 Number of pits----------------------Lining material-----------------------Size: Diameter----.---..-------------Depth._.__.__________------..--------. Cesspool: epth--------------------------------- Cesspook Distance from nearest well-----------------Distance from foundafion_ - _--- ---------Lining material-_..___--.._--------.__--------__-._. } ❑ aterial------------------------------------ ElSize: Diameter------------------- ------------------Depth------ -------------•---------- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------- -------.-Distance from nearest building----------------------------------------- ElDistance to nearest lot line---------------------- -------------------------------------------------------------- --------------- ------ ----------------------------- aRemodeling and/of repair;ng (cescrib� ee ---- -- - -- - ------------- - --f - --------------------------7------------------------------------------------------------------------------------------------------------------------------------.--4-------- -------------------------------------------------------- --------------------------------------------- ----------------------------------------------------------------------------------------------------------------- ---------- ---------------------------------I-- ------------------------------------------------------------------------- - - - 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. ( VSigned)............A1 --_"A_ ...4 - ----- -----d ---- --- ------------ - ----------------------- ----------(Qwam=Mm*/w Contractor) By:_------------------------------------------------ ----------------------------(Title) sx Pl`.4 5;;P V-5 0 e ------ ------ ----- ----- (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, efc., can be placed on reverse sW FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- --- --- DATE-------------------------------- --------------------------------- _\:�---- ----------- -- ---- ----------------------- REVIEWEDBY---------------•--------- - ---------------- -- ------- ------- ------------------------------------------- DATE ----------- --------• .......*------ -------- ------ ------- BUILDING PERMIT ISSUED_.--------- ------------------------ ------------------ DATE------------- ---- --- ----------- ------- ------------- -------- ---- --------- -- -------------------- ----------------- -------------- ----------------------------------------------- Alterations and/or recommendations:.-- ---- --- ------- - ------- -------------------Z------------------------------------------------ --------7-!,--r-------------------- ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ --------------------------------------------- ----------------- I------------I------ -------------------------------------------------------------- ------------------------------------------ ------------------------- --------- ---------------------------------------------------------I----------------------------------- -------------------------------------------------------------------------------- ----------- -------------------- te?FINAL INSPECTION BY:..... .5�--- ----------------- ------------ 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