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/ 7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. --(O"�.�-/-.--_ <br /> (Complete in Duplicate) <br /> . -Date Issued __e7h015 <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 A LOCATION 0 �--¢---------00 t-4t ------------------•-----••------- <br /> Owner's Name------ -�--4-�---'-----------���:-.��-af.--�°,r..-�!---------------------- - ------ ---- - -..................................... Phone------------------------------..... <br /> Address...... Q / -------------------------•---• �t <br /> n . <br /> Contractor's Name t fT 47 ------------------------------ Phone_ C7.� Q T <br /> Installation will serve: Residence •Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 1__._--. Number of bedrooms ---. Number of baths "_1.."_ Lot size .__ �...". .I ____........"._....... <br /> Water Supply: Public system) [K 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 0( Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes [A 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�,f� ­rf4 ce from nearest well---------------------Distance from foundation-------------------- Material------------------------------------------ <br /> Ur" No. <br /> ❑ f compartments---------------------_----Size---------------------- <br /> ----------Liquid depth ------------------ CapacitY•----- ------------ <br /> Disposal Field: Distance from nearest well.................Distance from foundation-.- ----------------Distance to nearest lot line.........-------- <br /> ❑ j�NuAer of lines ------------------------- -------Length of each line------------------- -- • .-.Width of trench <br /> Type of filter material-------------------------Depth of fi -- -----------------"7otal length-------------------------------•-ti._="--- <br /> Seepage , : Distance�to nearest well._._.._..............Dis nce-from_ fougda ion..._. d..__Distance to nearest loft line-. ----------- <br /> Number of pits.-------I------------Lining ma erieLe4 --,-_�--t...r<Size: Diameter_$_--i-_-----:_Depth----_- 2'r_---------------- � <br /> Cesspool: Distance from nearest well----------------- ' tante from foundati ---.."------------..Lining material.......... :_..----."-. ( <br /> ❑ Size: Diameter Derot ----------------- Liquid Capacity-------- .............. <br /> gals. <br /> 4V <br /> Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building-..-_.__--...--------.-----------___._.... r` <br /> ❑ Distance to nearest lot Iine-------------------------------- -------------- ---•---------------------•--------------------------------------------------------- -------- <br /> Remodeling <br /> ------Remodeling and/or repairing (describe)-------------------------------------- -------------•------------•-------••-----------•--------- ---------------------.---------------------------------- <br /> ------------------------------------------------------------------------------•-------------------------------------"-"--------------------•-•---------"•--------------------------• ---------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> t <br /> --------------------------- ----------------------------------••--------------------•-----•---------"---•-----------------------•------------------------------------------------------------------------------ <br /> 1 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:------ <br /> ���n�.+----�.-- ---,�.C�. ..E-ate+-------- --------------------------------------(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 'f <br /> .f <br /> APPLICATION ACCEPTED BY------ --- ------------ ! DATE-------- - <br /> - - --------- ----------------_------------- <br /> REVIEWED BY _' ------------------- ---------------------•------ DATE <br /> BUILDING PERMIT ISSUED---- ----------- --- - ----- - - ---------- <br /> DATE-------- V -------- <br /> Alterations and/or recommendations--------------- ��( <br /> -----------------"--------••- ----------------------•------------------------------------------------ ---------- �. <br /> -----•---------------------------•-•---• --- ------------------------------- ---••----•------------------------------.----- <br /> •---------------- ------------------ --- ------------------- ------------- ' <br /> FINAL INSPECTION BY:.....__. ._ �•� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Streat 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California <br /> Manteca, California Tracy, California <br /> ES-9-••2M 145446 ATWOOD 12-54 <br />