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APPLICATION FOR SANITATION PERMIT Permit No. ...a..3 G-_9- <br /> (Complete in Duplicate) /h <br /> P Date issued ____/ 716_ <br /> Applicaa-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 Ordinan '549. <br /> l - <br /> JOB ADDRESS AND LOCATION-.-I--La. -b -ejo------- -014--0 <br /> Owner's Name ` l FiF 7 Q 10 <br /> --------- ----- --------- Phone------------------------------------ <br /> Address--------0 ------ -------- _ ... :.. <br /> ------------------ <br /> Contractor's Name ---N- - -• ------C--[.1-----e Phone <br /> Installation will serve: Residence Er11Apartrnent House ❑ Commercial ❑ Trai er Court E] Motel E] Other ❑ <br /> r <br /> Number of living units::__.___ Number of bedrooms _'Number of baths..___- <br /> --- size --- <br /> Q ��----- _ --- -- <br /> Water Supply: Public system [�ommunity system`❑ `Private L] Depth to Wateriable—k— ft. <br /> t <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClaytDam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes [31-'No ❑ 4 T <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ; <br /> (No septic tank'or cesspool permitted if p blit s wer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-. -_- ..__Distance from foundation__1�.._._._---.Material_.--.C�c�1�r/�C, <br /> --- ---------------------------- <br /> No. of compartments ...__._ _ <br /> �. p - ------------Size-- -. ��.�_�r�7C. Liquid depth---e�-'�y[---- �Capacity.��-- -------- <br /> Disposal Field: Distance from nearest well_r---_..----Distant l I ou ation---ef----_--_--Distance to nearest lot line_....______ <br /> Number of lines-._.-/----___---_ .--.:Length of each line__��r------- -------_ Width of trench �..��_____.._________._ <br /> Type of filter material._ _- _ .. -Depth of filter material-_-_.l ----------Total .length----i __.�------------­------------- <br /> { <br /> Seepage Pit: Distance to nearest We <br /> - Distan from foundation-lb" ___, is ante to nearest lot line--.s.�___ <br /> Of Number of its....rr Linin material ----t-- -----....Size: Diameter.__. �" Depth __ __� � <br /> p f----------- g / --- pth-----�`� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation...............__Lining material-____-- - --------------------- <br /> .-._-_ De th-_-______________ -._--Li Liquid Capacity <br /> ❑ Size: Diameter------------ --------------- - p ------------- -- �- - - q ------------------------.._gals. <br /> Privy: Distance from nearest well---_---------_-----------------------------------Distance from nearest building <br /> ❑ Distance to nearest lot fine---------- ------- --- ------ -------------------------------'--------------------------------------- - <br /> - - ------------------------------------- <br /> Remodeling and/or repairing (describe):--------- ---------------------------------------------------------------•--•--------•----------------•-----•---------------•----•-----------••------- I <br /> ------•-----•--.-------•----••--------•--------------------------•-----------------------------------:-- --------•-•----------------------•---•-----•------ ----------------•---••---•-••---------•---------•---------- <br /> ------------------------------------------------------------•-----------------•----------•-•--------------- ----------------- <br /> ------------------------------------- =-------------------------------------------------------------------------------- <br /> --------------------•------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accord a with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> DAY�NIGHT(Signed) : - e - --------Septic.Tank Service----- jillst, b�uildings, <br /> ---- ------- - Contractor) <br /> 7 206 So.Eldorado HO 27046 {�r <br /> - ------•------•-•----g Ic ;Ccsli ,-------------------------- -------- --- ---(Title)----_ .-�,----------------------------------...... ' <br /> (Plot plan, showing size of lot, location of system in relation to a ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----------------------------- a - DATE.--------------- ---6 <br /> REVIEWED BY------------- -------------------------- - DATE <br /> BUILDING PERMIT ISSUED---------------------- -------------------------------------------------------------- DATE------ --- ----------------------------------------------- - <br /> Alterations and/or recommendations:------ t- ------- =----------------------=------•-------------•-----------------------•--------------------- <br /> ----•---------------------•--.---------------------------- <br /> ---------------------•-• ------••------------- •--••------- <br /> ----------------------------------- <br /> -------.---•-•-------------------- -------------------------------------- <br /> ------------------------------------------------------------------- <br /> FINAL INSPECTION B :.- -- - ------ ---- - ._ —---------- ' <br /> 4 <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Ameritan Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 ATWOOD <br /> rv�fi , <br />