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1307 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .._� ��... <br /> f (Complete in Duplicate) <br /> Date Issued <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 Ordinance No. 549. <br /> JOB ADDRESS AND LL 'CATION......... /-_ o< ---------- <br /> Owner's Name (�1.� -----•--- Phone <br /> Address---------�) --------•- - --- ---------- s� -------------------------------------------------------•-----------------•-------•---------•----......---•--.........---- <br /> Contractor's Name. •,[/ /T• - -� ------ Phone.#s_-.,u.'_9�A 7-- <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 11Number of living units: _/----- Number of bedrooms .;A--- Number of baths -_I___ Lot size ...... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe OHardpan ❑ <br /> Previous Application Made: Yes ❑ No (� New Construction: Yes El No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk• 6 is nce from nearest well__ ____________Distance from foundation....................Material--------------------------------------.__-_____-. <br /> / N of compartments---- ---------------------Size-------------..................Liquid depth--------------------------Capacity------ -•---- <br /> r <br /> Disposal Field: D•stance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. <br /> ❑ �bar of lines___________________________________Length of each line_______________._.-----------Width of trench----------------------------_------ <br /> 11` <br /> Tpe of filter material------------------------- of filter material-----------------------Total length--------------------_...................... <br /> Seepage Pit: Distance to nearest well_..._—_.._-____Distance from foundation.......?V.._........Dist?nce to nearest lot line----/Q_.j___ `- <br /> Number of pits---.----1-.----------Lining mate ria l_GC_9<4.e_t.Size: Diameter__, .---------------Depth---.o_2S__.................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material--._-_-____._---____-___----________•. <br /> ❑ Size: Diameter--------------------------- ----------Depth-.-•-----------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-------------------------------------_-----------Distance from nearest building-------------......_------•-_______-___-_. <br /> ❑ Distance to nearest lot line--------- ----------------------------------------------------------------------------------------------------------------------•---•- <br /> Remodeling and/or repairing (describe):......................................................................................................................................................... <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------- --------- -----------------------------------------------------------------(Owner and/or Contractor) <br /> By:._..` 6�....=------/---L (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 /> REVIEWEDBY------------------------------------------ - - ----- ------ DATE.............{..................................... <br /> BUILDINGEWIT-tSSUED------•-------------------- ...... ._.. --------------•--------------------------------------- DATE---------- ----.--X..------------------------------------ <br /> Alterations and/or recommendations______________________ _____ __ _ - ~ _ ._._...__...___._.. <br /> ---- <br /> -•--------------------------------------- --------------------------------------------- ---••----------------•---•-----•----......•--------...-•-••-..................... ......... ... .................... <br /> -----•------ --__-•--------------------------•--------•-------------------------------------------------------------------.-------------------- ..........--............................................................... <br /> --------------------------------.............................................. • ---•----------------------....._............--• ............. ......................­--------------------------------•--•--••-•----------- <br /> 4741- <br /> 4� <br /> FINALINSPECTION BY: ----•------------------------ -------------- 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 /> JES-9-2M 145446 ATWOOD 12-54 <br />