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.4 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ................. <br /> (Complete in Duplicate) Date Issued ---:�/171/sz <br /> Applical-ion is hereby made to the San Joaquin Local Health District for 'a permit to construct and install the wo ein st ted. <br /> This application is'made in compliance with County Ordinance No. 549. <br /> .....)21 12 L- ------- ------- <br /> JOB ADDRESS AND LOCATION---- --- -----�--- - -------------------- <br /> Phone-------------------- --------- <br /> Owner's Name--------------------- YtJ-------- 40-�_ - <br /> ----- --------- -----­.­--------­­------------------------- <br /> Address----------------------------------------- y-_e__j*'e- ----- --------- <br /> R <br /> Contractor's Name-----------------_--- ---------I'Vil", -------------------------------------------------------- Phone.-----_---------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel El Other Ej <br /> Number of living units: ---[--- Number of bedrooms -'-3--- Number of baths <br /> Lot size ------- --- <br /> Water Supply: Public system [] Community system F] Private 0--Depth to Wafer Table __#__ ft. <br /> Clay Loam E] Clay E] Adobe <br /> Cl <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam K75Hardpan El <br /> Previous Application Made: Yes E] No New Construction: 'YesNo 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-10-f-------Distance from fouriclafione�4--------- <br /> .....----_.Material_ c� ' <br /> Size-tr ----Liquid dep�h---41C' y-- ----------------- <br /> No. of comparfrnen'Is-----2," - ------------ apavcj� <br /> Distance from nearest well - D*sfance from foundation-Ap- I in <br /> Disposal Field: Distance ............Distance to nearest lot <br /> FX1 Number of lines-------2----------- <br /> Length of each line-------------- ,------.Width of french---vt --------------------- <br /> 4111_X-_Depth of filter material---- --.-.Total length-------I-J-6---------------------- <br /> Type of filter material----5z <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----__-----.-._-_Distance to nearest lot line----_--------_--_ <br /> ❑ <br /> ine----------------- <br /> El Number of pits--------------------_Lining material-----------y----.---.--Size: Diameter-----------------------Depth--------------------------------- 0 <br /> Cesspool: Distance from nearest wnll-----------------Distance from foundation____.._.___--.---- Lining material------------------------------------- <br /> . 0 Size: Diameter----- ----- ------ _ __....------Depth----------------------------------- ----------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well------_------------------------ _ -----.---Distance from nearest building_-__.----------------_.---__------------. <br /> El Distance to nearest lot line- - ---- - -------- - ----- -------------------------------------------------------------- --- ---- <br /> ------------------------------------------ <br /> Remodeling and/or repairing (describe):------ ---------- ------------ -------------------------------------------- ------------------------------------------------------------- <br /> —------ <br /> --------------------------------------------------------------------------------------------------------------------- -----------------------­------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ---------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- _"---- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> "� <br /> ordinances, State laws, and rul" alb egulatio of the Sian Joaquin Local Health District. <br /> ...... ..... <br /> {Signed) &�...G�__a .,Joe-------------------------------------------------------------------(Owner <br /> a <br /> n <br /> d <br /> /or <br /> Co <br /> n <br /> tr <br /> a <br /> c <br /> to <br /> r <br /> ) <br /> By:---------------------_-_------------------ --------------------------------- -----------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> PA!&ENT U ONLY <br /> APPLICATION ACCEPTED BY- --------------- DATE------ >-76------ <br /> REVIEWEDBY-------------------------------- -------- -- --------- ------------------------------------- -------------------------------- DATE------ ------ -------------------------------------- ------ <br /> BUILDING PERMIT ISSUED--------------------------- ----------------------- ------------------- --- --------- DATE_' --------------- --*------- <br /> ........................... <br /> Alterations and/or recommendations:.___-------------------.......... ---------------------------------------------------------------------- - ------------------•------------ ---------------- F <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------ <br /> -------------------------------------------- --- ---------- ------- ------%----- -------- ----------- ­­------------------------------------------------------------ ---------­------------I'll-------------­------------ <br /> -------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- <br /> --------------------------------------------------------------- - - -- ----------------------------------- ------------ ----------- --------------- --------I.......----- <br /> ---------------------------------------------- <br /> FINAL INSPECTION BY--------- ------W -- - - ----- ------------ Date.. -------- - <br /> V <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American S+resf 300 West Oak Street 132 Sycamore Streef 614 North "C" Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> Ls--9-2m 14s446 ATWOOD 12.54 <br />