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Permit . <br /> APPLICATION FOR SANITATION PERMIT -(Complete in 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 Ordin 549. <br /> JOB ADDRESS AND LOCATION___g-. _____15- - ._ <br /> --------------------- -------------------------------------------------•---•--• -------- <br /> Owner's Name-----Z- - ---- - --- w ----------------------------------------- Phone-------- -------------------------- <br /> Address....... -- 4:.. .. Y <br /> Contractor's Name_ ... f._ .. ---- ----------- Phon .�� ---"-- - --- <br /> Installation will serve: Residence// (��artment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other D <br /> Number of living units: __C___- Number of bedrooms __4—Number of baths ---I---- Lot size0'. <br /> _.. �0________ --C .-�_ _--._-_--- <br /> Water Supply: Public system [��mmunity system El Private ❑ Depth to Water Table-—--- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3 Clay ❑ Adobe ardpan ❑ 1 <br /> Previous Application Made: Yes ❑ No lew Construction: Yes ❑ No [jr— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tan Distance from nearest well.................Distance from foundation------------ Material__----.--._-.-..-----..-_______---------___-.-_. <br /> '' No. of compartments------- -- --- ----- - ---Size--------------------------------Liquid depth-------------------------Capacity----------------------- <br /> D sposal Field: Distance from nearest wer--------------Distance from foundation----- 6~-----Distance to nearest lot line-j-0........ <br /> [}-- Number of lines---------- ..... . ..... .. Length of each line-------------Z --------Width of trench...2-K fI-----------.-_-_--.- <br /> Type of filter material--- --------Depth of filter material------1__67-------- otal length---.-'.._�____-_______----_---__-__ <br /> Seepage Pit: Distance to nearest well----------------------Distance fjL9m foundation.--_ '_Distance to nearest lot line_ —el------- <br /> [ {dumber of pits-----/--------------Lining materiaSize: Diameter-----4(.2r.......Dept n-...e�0-__---_______.------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material --_-___------.----.._--------------- <br /> . <br /> ❑ Size: Diameter----- --------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. O <br /> Privy: Distance from nearest well---------------------------._.--------.----------Distance from nearest building-----.-------------------...------ -__ <br /> ❑ Distance to nearest lot line----------------------------------------- ---------------------------------------------------------------------- ---------- <br /> Remodeling and/or repairing fdescribe):------------------------------------------------------------------------------------------------------------------------------------------ <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, St e. law and r and r ulafions of he San Joaquin Local Health District. <br /> (Signed) ontractor <br /> -- --------------- -------- c'-a -mac --------------------- - --- <br /> Eiy:. ( iA• - i (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 /> APPLICATION ACCEPTED BY---- ------- ---- ---------------------------------------------------------- DATE---------10 <br /> REVIEWEDBY----------------------------------- ------- ---- --------- ---------------------------------------------------- ----- DATE----------- -------f------------------- <br /> 13UILDIPJG PERMIT ISSUED ------------------ - DATE. 1 - - - - <br /> Alterations and/or recommendations----------------------- --�------------------------------------------------------------------------------------- <br /> -------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- -------------•------------------- <br /> ----------------------------------------- ------ -- -------- --------------------------------------------------------- ---------------------•-------•--------- --------- ----------------------------------------------- <br /> FINAL INSPECTION BY:......... -----_ ._._ `S`--•--------------------- <br /> Data-------------------- <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-9-2h1 145446 ATWOOD 12-54 <br />