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APPLICATION FOR SANITATION PERMIT Permit No. <br />42J <br />(Complete in Duplicate) 0 <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 LOCATION-_ . ------------- _ -� <br />-•----------------••-----------------------------------• -------------------------------- <br />{ Owner's Name <br />........ <br />-----_ ------- s.C�l -------------------------------- Phone <br />Address ----------------- <br />-r. <br />Contractor's Name CGU - ----------------- Phone---- <br />Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel 0 Other 0 <br />Number of living units: __%._ Number of bedrooms_.. Number of baths . __--_ Lot size <br />X ------------ <br />Water Supply: Public system tZ� Community system ❑ rivate Depth to Water Tab] -------- ft. <br />Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay 1 <br />p ❑ ❑ Y ❑ Y ❑ y ❑ Adobe' Hardpan ❑ <br />Previous Application Made:' Yes ❑ No ❑ New Construc#ion : .'Yes ❑ No ❑ <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 nearesr well --<5.—b.... Distance from foundation-_ 20--_--__-.Material--�_1=_ 1_ , <br />No, of compartments ----- _..._ <br />---Size__3--�C-,S:_. Liquid th_- <br />.-_ <br />P. ..------------- <br />Capacity ----- --0-Z------ <br />J <br />Disposal Field: Distance from nearest well ... ,��.._ Distance from foundation --- .-�.-C?.•._.Distance to nearest lot line ___..__.____ <br />Number of lines_________ ____ Length -of each line ----- ... __ � ` <br />�Uc -------Width of trench ----- <br />----------- <br />------X <br />Type of fitter materialWWtk:&filter material.__. ---f __._...._Total length -------- Seepa e Pit: Distance to nearest wO------- -------------- Distance from foundation ----------- ..._..Distance to nearest lot line <br />Number of pits---------------------- Lining material ----------------------- Size: Diameter ----------------------- Depth- ---e5y--------------------- <br />--- _� <br />o : Distance from nearest well----------------- Distance from foundation ---------------- _-.Lining material __..-_--_-._-_------._._---_-__-_--_ <br />Size: Diameter ------------------------- ----------- Depth ----•----- -----------•-------- -------------------Liquid Capacity ---------------------------- gals. <br />Privy: Distance from nearest swell-______ <br />Distance to nearest lot line --- <br />_____-------------------- _------------- Distance from nearest building ----------------------------------------- , <br />❑ ---------------------- -------------- ----•--------------------------- <br />Remodeling and/or repairing {describe:--_-- -- <br />-----• --- <br />{ <br />---------- ........ .------------------------------------------------------ <br />---_-____---.----._------__-__-_--_-_- ----------------------- <br />.--------------------- ___ _�~ <br />------------------------------------------------------------------------- <br />__________________________________________________________________........ _------------------------------------------------------------------ <br />__ <br />------------------------------------ _------------------- _------------- <br />----­------------- ­ ---------y_____.__-____. -------- <br />_---------------------------------------- -------------------------------------------------- <br />I hereby certify that I have ,prepared this applicatio nd that the work will be done i ccordance with San Joaquin County J <br />ordinancXSf laws, and ru an reg ion f t an Joaquin,,Lacal Health District. <br />(Signed)-__-- ------ ---- -caner an t <br />--"----------------------------------- (Owner and/or Contractor) <br />ractor) <br />By:----------------------------------------- -------------------------------------------------- _ __ _.t (Title) ---------------------------------------------------------------- <br />(Plot pan, 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 />w <br />APPLICATION ACCEPTED BY ----------------- -------- ---- --- =-----------•----------------------••------------ DATE ------ <br />-------------------------------------------- <br />REVIEWED BY --------- --------------------------------------------- DATE-------- = .�. <br />BUILDING PERMIT ISSUED ---------------------------- ------ ---...------------•----=-------------- --------- DATE--------------- ---_.- <br />Alterations and/or recomme dations:_ ..............__._.. <br />s� ------------- <br />------ <br />--- <br />--- <br />---- - - - -- - -- ---- --- <br />- --------------------------- ---------------------------------------------------------------- ----------- -- <br />- ---------- ------------------ ----------------------------------- <br />---------- <br />q <br />--------------------- ____ •_.------------ _ .._.._---------- <br />_. ----------------- ...___-_-. __.__.... ____.___.. __. _ <br />........... ....--------------------- -------------------I----------L------ <br />FINAL' INSPECTION BY:.---- - -------------------- `�.- 1 <br />----�:--- - - - Date---------------------- t ----------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 So'ufh -American.-Street 300 West Qek Street 132 Sycamore Street <br />Stockton, California Lodi, California Manteca, California <br />�rEs-9 745446 ATWOOD <br />814 North "C" Straet•-,__ <br />Tracy, California <br />