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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) s--!77 <br /> Date Issued --- <br /> .Applica4-ion is hereby made to the San.Joaquin Local Health District for.a permit to construct and install the work herein described. <br /> This applicati.on is made in compliance with County Ordinance No, 549. YV A� toy— 190-0-2— <br /> JOB ADDKESS AND 1C TION_!2.P/t----- --------- -------1---- 14.14A --------------- <br /> P A. - t <br /> Owner's Name.-_.__jw/w_ --------- 0.. ------- -------- -------- - ----------------- <br /> -------- -------------------------- ----------------------------------- <br /> 6 <br /> Address------------ ------ <br /> --------------------------- Phone----------------- <br /> --------4— --o— <br /> Contractor's Name------ <br /> Installation will serve: Residence �Apartment House 'El Commercial ❑ Trailer Court El Motel El Other <br /> ❑ <br /> Number of living units: .-/-- Number of bedrooms _,�. 'Number of baths/-,k-Lot size ---------I,. ------------------ <br /> Water Supply: Public system El Community system E] Private [;aLDepth to Water Table :2d It. <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel El Sandy Loam [-] Clay Loam [] Clay ❑ Adobe � Hardpan <br /> ❑ <br /> Previous Application Made: Yes Ej No Vg,_ New Construction: Yes &_.No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f---- <br /> Septic Tank: Distance from nearest well-_-f6---- Distance-from foundation------(""-4...... <br /> No. of compartments-----. ----Size---cj".5_ZQ--- Liquid depth------ - ---_..._.Capacity___ ------------------- <br /> Disposal Field: Distance from nearest we]---- Distance from foundaf ion____Z6.-/.....Distance to nearest lot <br /> Is --- ...r -Width of <br /> J4 Number of line -------/--------- ----Length of each -line ------- <br /> T ' e of filter material---1-a-------_5A&pfh of fiIter,mdfer4_..._/S----------Total length---------:::;7.5---- ---------------- <br /> yp r <br /> Distance to nearest well___,�'47' .........Distanc'e, fromfound pflon---(;20- --------Distance to nearest lot line--7-F- <br /> Diameter_ :---------- <br /> Seepage Pit: Number of pits-----/-------------Linin-9 material__ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_..-_.._._.......Lining..............Lining material------------------------- <br /> El ---- <br /> S&: Diameter---------------------------- - ------Depth--- :----------­­---Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-'----------------------------------------------Distance from near I es+ building-----------------------------------------. <br /> ❑ <br /> uilding---------- ------------------------------ <br /> ElDistance to nearest lot line.--------------- ---F----------------------8------•------.---------- --------------I----------------------------------I-------------- <br /> Remodeling and/or repairing (describe):--------- ------------------------ ------------------------------------------------------------------------ --------.....-----------•--------------------------------------------------------------------------- <br /> ---------------------------I--- ----------------------- ---------------------------------------------------------------------------- ---------------------------------:--------------------------------------------------------- <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 /> ordinances�, �Stafell;w and rules and regulations of the San Joaquin Local Health District. <br /> --------------(Owner and/or Contractor) <br /> --------------------------------------- -------- <br /> - <br /> (Signed)--- --- ---------- ---- -------------------------- <br /> - -------------- ---------------------- ----- <br /> By:....... ---- -- ----- ---- -- -- ---- -----0112 -------------(Title)----------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------- ------------- --------------------------------- --- DATE---- -------- - ------------------ <br /> ------- DATE_------------- - ----- -7-----•-------- <br /> BUILDING --------------- ------ <br /> REVIEWED BY------------------------------------- ----------------------- <br /> PERMITISSUED------------- --------------- ------- ------------------ ---------------------------.... DATE--------------------- -----------------------------:------ <br /> Alterations and/orendation5:.- . ..... . -----------9i---J_ --------------------------------- <br /> ------ ---------- __c ---------------------------------- <br /> ------------------------- <br /> ---- --------------------- --------------------------------------------------------------------------------------­-------------- <br /> ------------------------------------------------------­- -------------------------- <br /> ---------------------------------------------------------------------------------------- ------------------------ ---------------------------------------------------- -------------------------------- <br /> ------------ --------------- ----------------------------------------------­... .....­­-------- ------ -------- ------------­--------- ------------------------------------------------------------------------------- <br /> -Y <br /> FINAL- INSPECTION ------- ----------I------ .... Date----- .. .................. -------- - --- ---------------------- <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 /> $-9 145446 ATWOOD <br />