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APPLICATION FOP. SANITATION PERMIT Permit No. <br /> 1% ((Complete in Duplicate) <br /> I Date Issued ---- /A­SJZ <br /> . ___ <br /> 0--_? C.0,-4-- _-Y­t OU-0-ild- 2-Yy--0,310 --( z- <br /> -) Z Health District for a permit to construct and install the work herein described. <br /> kp7rica14-ion is hereby made to the Son Joaquin'Lo <br /> This application is made in compliance with County/Ordi ante No. 549. <br /> JOB ADDRESS AND LOCATION--- ----4011��_IL-------------- <br /> ---- ---- ----------- --------------- <br /> Owner's Name ----- Phone------ .......... <br /> .Al----------- ------- ------------------ --------- ----------------------------- ------------------- <br /> ---------- -------------- -------Y-------------- ------------------------------------------­--------------------------------------------------- <br /> o/el E3 Other El <br /> Address.-..----------- ------------e-- -- --- <br /> Contractor's Name----------------- -------------------------L-------------------------------------------------------- --------- ------------ Phone----------------------------------- <br /> Apartment House Cj Commercial �E] Trailer ourt E] M <br /> Installation will serve: Residence 0 <br /> Number of living units: I---- Number of becli­6�oms Number of baths I--- Lot size ---------- <br /> Water Supply: Public system E] Community system [3 Private,n Depth to Water Table -4.-()ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam K Clay 0 Adobe❑ Hardpan <br /> Previous Application Made: Yes E] No 14 New Construction: Yes No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se t' Tank: Distance from nearest well-_/0'�9-Disfan e frpm foundation---- -------Materiali- ------- ------ ---- <br /> 12 No. of compartments------- L depth_ Capacity.... <br /> _g---- .__Size..__.. ... <br /> Disposal Field; Distance from nearest we1I_.A5k_Distance from foundation-_-S-1t)......Distance to nearest <br /> .... Width of french.,;2- <br /> Number of lines___.__ ----Length of each line_-_j ------------------ <br /> .x Type of filter material-- �,_Depth of filter aferial---- -Total length------- ---- <br /> Seepage Pit: Distance to nearest well------------- :------Distance fro f0&UV1a`tk,0j,(_� -------.-.Distance to nearest lot <br /> et(2 <br /> Number of p:fs----------------------Lining material---------_._-- ____.Size: D* eter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well--------- -------Distance from foundation.............._-_-.Lining material---._....___-______._._.____---_-_-- <br /> --------------- <br /> _. Size-.-Diameter�.......—--------- ------- ---------- <br /> Privy: Distance from nearest well ..... ij-----------------------------------.--Distance from nearest building_.____._____-----___----__------------ <br /> 0 Distance to nearest lot I* e..........------- - ------------------------------------------------------------------ -------------------------- ---------------------------- <br /> 'Modeling and/or repairing (describe): 71 ..... <br /> Re ribe): -------- ---- --------r---------- -?- <br /> ----------------------------­­------------------------------------ ---- -------------------------------------------------------------------------------------------------------------------- <br /> -----------------------I----------------------------------------------------------------------------------------------------..........------------------------------------------------------------------------------------ <br /> ------------------------ ---------------------------------------------------------------------•-----------....----------------------..__..----------------------------------------------------------------------------------- <br /> of I*-e <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(a-ndregul�ationsof the San Joaquin Local Health District. <br /> (Signed]:'-------- ------------------ ----- -----------------L---------------- --------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------ -- ---------- ------------------------------------------(Title)------ ----------------------------------- -------------------- <br /> (Plot plan, showing size of lot, location system in 'relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- -------------- ------ ---- ------------- --------­-­------------------.- DATE-------------------- <br /> ,--,- ---e------------------ <br /> REVIEWEDBY-------- ----------------- ----------__.... ............ ------------------------------ DATE----- --- --------------- <br /> BUILDINGPERMIT ISSUED------_----------------------- --------------------------------- DATE-------------------/----------------------------------------- <br /> Alterationsand/or recommendations----------------- ---- ------ -------------------------------------------------------------------------------------------------------.....-•-------- <br /> ------------------•--------------------------------------------- <br /> -*11*1-1-------- <br /> ---------------------------------------------------------------- ------------I----------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------- ---------- ------------------------------------------------ ------------------------------------------------------------------------------------------------ <br /> --------------------- ------ -------------------------------------------------------------------------------------------------------------- ------- -------------- -----------------------------------------------•----------- -------------------- ---- ------ ...... ....---------- ------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY----------------- ------- -------------- Date..------- -ral------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycarn*ro Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-21M 145446 ATWOUD 12-54 <br />