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APPLICATION FOR SANITATION PERMIT Permit No. '__Q AI.4_._.. <br /> )A V (Complete in Duplicate) E(I <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 de/scribed. <br /> This application is mad in compliance with County Ordinance N . 549. <br /> JOB ADDRESS AN OC ION _-----���7 r <br /> Owner's Name.---•--•--...... ��— �� �V--- <br /> Owner's •--- <br /> Address----•-•-•----•••-..•-•••-••-•--••---••� •--•:.:.-X 7`" � ---------- <br /> `'. �,,��' <br /> Contractor's Name------ _- --- - __ Phone'�7`a.•;;;�.7C?,5 <br /> Installation will serve: Residence W4---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: O_-. Number of bedrooms 1____ Number of baths J.._ Lot size ------ '— -_ __ - ______________ <br /> Water Supply: Public system 12--t-ommunity system ❑ Private ❑ Depth to Water Table .3rvft. <br /> Character of soil to a depth of 3 feet: and Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2,-Nardpan ❑`� <br /> Previous Application Made: Yes No New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t� Q <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic - Distance from nearest well ______________Distance from foundation__.__________..___..Material_________------------------------------ <br /> ---------- <br /> No. of compartments--------------------------Size--_--------------------------Liquid depth--------------------------Capacity----------_----- - <br /> i pos field: ' Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. <br /> ?� - - Number of lines----------------_------------------Length of each line-----------.____. ............Width of trench___________._.____................. <br /> Type of filter material-____ _...________,__Depth of aterial___..____--_.....�.Total length______________________________ ......... <br /> Seepage P Distance to nearest�"eIL._ : ___Distance€-fro foun etion____.!-d____.•. 'st ncce to nearest lot line__•r�_.___ <br /> Number of pits_-_--/___-----------Lining material---------- ____ _-Size: Diameter.___.--_._____Depth_:...1p-__.•h'' <br /> Cesspool: Distance from nearest well-----------------D tance fro ' oundation--------------------Lining material-------------------------.............. <br /> ❑ Size: Diameter--------------------------------------De ------------------------------------ --------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-------____---------------_-------_--------_-----Distance from nearest building--------------------------------.......... <br /> ❑ Distance to nearest lot line----- ----------------------- ------•--------------------•----•----•-----•--••----------•---------------••--•------------------------•------ <br /> Remodelingand/or repairing (describe):-------------------------- ---------------•-••-----••••-•-------------------•••-••-•--------•---•--------•-------._..__...------------------------•----- <br /> ---------------•--•-----------•-------------------------------------------------------------------------------.--._..------------------------------------------------------•------------------•------------------------------ <br /> -----------------------------------------------------------••------------•---••••--------•-----•---•-••----•-••--•-----•---••-----•-------•-•-----•--••-•--------------------•------•--••--••--------------------•----------- <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 re ulations of the San 4paquin Local Health District. <br /> DAY&NIGHT - <br /> (Signed)_.__ Septic Tank Service Contractor] <br /> ---- -------------------------- <br /> By:.* <br /> --- - -------- -- <br /> 1 06 So.E orado Ff 2-704 -------------` - ,{ ----- <br /> By:•--- _. -----------------------Stockton;,-Calif,-------------------------- ------------------------- ---------­- --- ----------- ------- <br /> (Plot plan, showing size of lot, location of system in relation o wells, building etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------_---------------- - ...... DATE------------,l........................................... <br /> REVIEWEDBY...................... --------------------------------------- ------ DATE-- ----------- <br /> ...;,e...•---••-----•••----•------------- <br /> BUILDING PERMIT ISSUED........................................ - - DATE =e�= <br /> Alterations and/or recommendaf ns: ... ___ _ __ _________.._ ._ �..___._ <br /> :: <br /> -. <br /> --------- <br /> -- ......................................... <br /> -------------------------------------- <br /> FINAL INSPECTION BY:......... -_---------------------------- Date.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfockfon, California Lodi, California Manfeca, California Tracy, California <br /> ES-9 145446 ATWOOD , <br />