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�. <br /> APPLICATION FOR SANITATION PERMIT `r} Permit No. :_.11llo. ____ <br /> (Complete in Duplicate) l <br /> Date Issued. <br /> Applies-ion is hereby made to the San Joaquin Local Health Distri oe a permit to construct and install the work herein described. <br /> This application is made in compliance with County dinance 9. <br /> JOBADDRESS AND LOC TION----------- .---0------------ -••-----••-••••---- ........................................................----------------------------------•---- ----- -- ••. <br /> Owner's Name............... - ..i..... -- -•-- ---- --------­ Phone .Jp7 <br /> Address...................... •- ....................... ------------- <br /> Contractor'sName -------C ----------------------------------------------------------------- <br /> -------- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Tr <br /> ail Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I---- Number of bedrooms ._Number of baths size ..._.._� ---"�:------------- <br /> Water Supply: Public system av___C�ommunity system ❑ Private ❑ Depth to Water Table h/oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobegr-lHardpan ❑ <br /> Previous Application Made: Yes ❑ No []--"N`ew Construction: Yes ❑ No ❑ j_/7b i e-•y- 4 4,t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: / <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep ' Ta �._ vDistance from nearest we- '.4 _-_-----__Distance from foundati , <br /> hof compartments----Qw --" -Size __- °� _Liquid depth' :�'t Capa <br /> -------- -- -- <br /> x <br /> Disposal Field: Dis nce from nearest well-----------------Distance rom ou dation.__.___--__.-_-.:_-.Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------------------Lepnghof - --- ---------------- .......Width of trench ................................. <br /> Type of filter material.----_-_----------------Demater• I-- --_-_._.--.._..__-.Total length.___...._......._..._.....__.________._... <br /> Seepage Pit: Distance to nearest well._-j'�Q�+ -_Dio dati _l�_--•_--...Distance to nearest lot line_..a�__.•..... <br /> Number of its.--- --Linin mat � Si • Diameter----. 3.. De th------��`.-----...--- <br /> Cesspool: distance from nearest well-----------------Dio dation._.-------..-_:.--.Lining material__--_----_---_-__-_--______._•-.---.-.Size: Diameter--------------------------------------De __--___-- .-- - . .......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 /> I herebynlaws,Lanules <br /> ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, atand ;�e�ofJoaquin Local Health District. <br /> al(Signed) -------- ( Contractor) <br /> By:.................................................................................... (Title) � � 0-±�- <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, et ., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------------.---------_._ _ _ DATE............ .. <br /> - <br /> ----------------------------------=------------------ <br /> REVIEWED BY------------------------------------ ----------- DATE----- ... !___ ._............................ <br /> BUILDG R <br /> IN PERMIT ISSUED. ------ ------------------------------------------------------------- DATE-----........................................................ <br /> Alterations and/or recommendations------------ --------------------- -----------=-----------•---------------------------------------------------------•-------•--------------.........--•-•-•- <br /> -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------•---------------•......... <br /> ..................... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ••---------------------------------•-----------.------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- <br /> - -----•--------------------------------------------- ---------------------- -----------------------------------------------------------------------------------•----.----------------------------------------- <br /> 1 � <br /> FINAL INSPECTION BY:.--------- =fit --------- -•---------------- Date.....Z..... � <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 /> ES-9-2M 145446 ATWOOD 12-54 <br />