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APPLICATION FOR SANITATION PERMIT Permit No. ------------- <br /> (Complete in`Duplicate} Date issued YA-d <br /> Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ord;-nante No. 549. <br /> -------------------- <br /> JOB ADDRESS AND LOCATIONI.!�__ ---- --------- IV-0—d- ---------------- <br /> ------------- Phone----------------- <br /> ---------------------- -------------------- --- ...... <br /> Owner's Name-------7 <br /> Address-------- 1\------------A.-Y --------------------------------------------- ----------------------------------------------------- <br /> ----------- ------------r------------------------ ----------- <br /> Contractor's Name----------- ------------ Phone--------- --------_---------- <br /> -------------------- --------------------------------- <br /> is <br /> Installation will serve: Residence (Ajp�rtment House E] ' Commercial [I Trailer Court E] -Motel 0 Other El <br /> Number of living units; -1----- Number'of b6drooms Number of baths_J_77-Loti size ------ <br /> ---------- <br /> Water Supply: Public system El - Community system F1 Private, Depth to Water-Table ___---__-ft. <br /> Character of soil to a depth of 3 feet: Sand F Gravel E] Sandy Loam El Clay Loam QIClay' ID Adobe, Hardpan ❑ <br /> ew Construction: Yes ❑0 No <br /> Previous Application Made: Yes [] No . N <br /> i, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if public sewer.is available.within 200 <br /> Distance from nearest we <br /> Septic Tank:, well_. Distance from foundafion ___Material------------- -------------------------- ------- <br /> No. of compartments-------------- --------------Size--------------------------------Liquid depth--f----------- -------------Capacity----------------------- <br /> Disfan�e'to nearest lot line___.-___.________ <br /> ----------- <br /> tD;spospepll Field: Distance from nearest well........ Distance from foundation <br /> 0 Number of lines------------------------------f- __-Cength of each line---------------------- ---------Width of french---------------------------------- <br /> 0. 1P <br /> or length_____________________________ _____. <br /> T filter material---- Depth of filter material___.__ Total length <br /> --------;;; ----/--- y 0 <br /> Seepage Pit: Distance to nearest well / 5�6-------Distance from founclatipri---4-------------.4itance to nearest lot line.15 <br /> --------------- <br /> Ing %F--------- <br /> material- -- --------- ------Depth <br /> 171 Number of pits---- I---------------Lin Diameter._-.r. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation --------------- maferia ---------------- <br /> _,,�iqu <br /> -Depth-------------------------------- ---------- "icl,Capacity <br /> Size. Diameter----------------- ---------------- <br /> -- <br /> Privy- <br /> Distance from nearest well------------------------------------------------Distance from nearest building.__.______._.._--______________---_----- <br /> -------- <br /> Distance to nearest lot line------ .. ----------------------------------------------------------------------- ---- ---------------------------------------------- <br /> t <br /> -------------------------------- <br /> ------ --------- ---------------------------------- <br /> Remodeling and/or repairing {describe):----aZ <br /> ....._12.4we <br /> ----------------------------------- --_--------------- ------------------------------------ <br /> -------- ----------------------------------------------------------------------------------------------------- <br /> --------------- <br /> ------------------------------ - <br /> -------------------------------------------------------------------------------------------------------------------------------T.,e------------------I-------------------------- ------ <br /> ------------------------------------ -------------------------------------------------- --------------I-----------------------------------------------------------------------------------------I------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> --------------------------- --------------------------(Owner and/or Contractor) <br /> By----------- <br /> L- -------------------------------------/- -----------------------------------------------.------------------- -----(Title)-------------------------------------------_ <br /> ------- -- --- <br /> �-_(Pl0tplan�showing-siziW-of,Ilocation-ofsysfer�in�relation-to- 6[lsI�biiildings�6tc; -can-b6=placid-on-reverse si <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-_ --------------------------- ----- ---- ------------------------------------------------- ---- DATE-------------------------- ----------------------------•---- <br /> REVIEWED <br /> ATE------------------------------------------------------------ <br /> REVIEWEDBY------------------ ------------------ - ---------- _/---- ---- -- ----- - -------------------. DATE-------- - I---- -------5---- -------- <br /> , _------------------- ...... <br /> :I- �4 -------------- DATE. <br /> BUILDING PERMIT ISSUED------------------ ------------------ �! _r <br /> � , 7 �._� ­----------------------------------------------------------------------- <br /> -- -- - ------------------------------- <br /> ---- ------ - <br /> Alterations and/or recommendations:-------------- --- -- <br /> --------------------------­------------------------------------------------ ------------ --------------------------------------------- ----------------------------------------------------------­­­.­-------------- <br /> ----------------------------------------------------------------- --------------------------- -------- -------------------•------------------------------------- <br /> -- - -------- <br /> ------------ ---- ---- - ---------- ­-------------------------------------- -------------------------------------------------------------I------- <br /> -- /- - - - •--FINAL INSPECTION BY: - ---- s .......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 175-9_2m 145446 ATWOOD 12-4 <br />