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­4� Permit No. <br /> APPLICATION FOR SANITATION PERMIT -7.---_- <br /> (Complete <br /> 7--------- <br /> (Complete in Duplicate) <br /> Date Issued --- <br /> L <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to cons+7t,__ all the work herein-dascribed. <br /> XTI <br /> This application is made in comph C 'th Aunty Ordinance No. 549. <br /> _q�� QY <br /> JOB ADDRESS A L CA ------ --- . ... ... <br /> ---------------- Phone------------------------------------ <br /> Ow'hei - ------- ------------------------.......... ---------- - -------­---- <br /> r� <br /> Adda.;.?------- ----- ---- --- ---- --- --- - - ­ ------------- -------------------------------------------------------------------------------------------------- <br /> --- -- ---------------------- <br /> Contractor's Name---- _2t__A7---- --- ---------------- --- ----- -_ ------------------------------------------- Phone --- ---- 7Of her <br /> Installation will serve: Residence 0_ Apartment House [I Commercial E] Trailer Court [3 Motel E] <br /> Number of living units: _/----- Number of bedrooms 7—. Number of baths __/---- Lot size ------------- <br /> Water Supply; Public system FZ Community system [I Private El Depth to Water Tabled ft, <br /> Character of soil to a depth of 3 feet- 'Sand E] Gravel El Sandy Loam El Clay Loam [I Clay ❑ AdobeZ__Hardpan E] <br /> New Construction. Yes &L_No Ej <br /> Previous Application Made: Yes [-] No P__ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -------Mat (�U _--_---.-- <br /> -.--------. <br /> ------- ......... <br /> Septic Tank: Distance from nearest well istance from founclation-_/,0_ <br /> ---------- <br /> vp No. of compartments_._-_. __e-_.Liquid depth....-�la_0-----------Capacity-•---- - <br /> Disposal Field: Distance from nearest well_),V67V_Distance from foundation_-- ----------Distance to nearest lot lines-- <br /> rline------ trench.-.-_ �/-------- -- <br /> Number 01 lines--- ---------_--Length of each ---- 'Width of trei ir ----------- <br /> Total length--------- ___________---_-_ � <br /> of filter material-- -,9-IF—.Depth of filter material_ .-.-- -------- ---- <br /> T J0-_ ---- i---- <br /> 'fo-nearest well__/447 Distance from f�vjridatiop-----------........Distanc -------- <br /> Distance e -i--------- t <br /> Seepage Pit: �o nearest lot line-.._-_` <br /> Number of pits-------- -------Lining material-6 Dia .&ter-----:6--f-------Depth----- � ---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_ -------------------------------- <br /> ElSize: Diameter--- ------------------------ ---------Depth-- .---------- -----------------------:---_---------.Liquid Capacity--------------------•------gals. <br /> Privy- Distance from nearest well---------- ------------------------------------ _-DiJance from nearest building-__-_--.----..----_---_---,__-:----------- 'ir <br /> Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------ ---------------- <br /> ❑ <br /> Remodeling and/or repairing (describe):_----- ----------------------------------------------------------------------------------I-------------- ------------ <br /> ---------------------------------- ----------------------------------------------------------- <br /> -------- -------------------------------------------------------------------------------------------------- <br /> ------------ ----------------------------------------------------------- ---------------------------------------------------------------I--------------------I---------------------------1-11------------- <br /> ------------------------ ------------------------------------------------ <br /> -----------------------------------------------------------------------------------------------­­­---­----------------------- -------- <br /> I hereby cerfif that I have prepared this application and that the work will be done in accordance with San Joaquin Gmdj, <br /> ordinances, Stat .1ra s, and rulesrand regulations of the San Joaquin Local Health District. <br /> (Signed)--------- --------------- .... ---------- - ---------------------------------------------(Owner and/of,Contractorl <br /> ifle)------ ------------------------------- <br /> By:------- ------(Title)----- - - ----- ----------- --- <br /> (Plot plan, showing size lot,_Iocati6'n__of system in relation to wells, buildings, etc., can be placed ,on-reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ATE-RAPPLICATION ACCEPTED BY---- -- ---------- Z.: -------------f------- <br /> ------------------------ DATE- <br /> REVIEWED <br /> EVIEWED BY-------------------------------- ------------ ---``----------� --------------------------------------------------- D <br /> TE------------------------- ----------------------•------------------- <br /> BUILDING <br /> -----------------------------------------BUILDING PERMIT ISSUED-_------------------------------- ---81- ------------ - DATE. <br /> Alterations <br /> TE- <br /> Alterations and/or recommendations:------ ---- --- -------- <br /> ---- ----- ------ - - �f <br /> --- ---------------------------------------------- -------------------------------- <br /> ---------- <br /> ------------ <br /> -------- <br /> ------ --- ---------- - -------- ------------------------------------------ ------------------------------- --------- --------- - ------------- ------------------------------------­-------------- <br /> - <br /> i I . ---- ---------------------- - ------ ----------- --------­--------­-------------------------------- <br /> -------------------------------------------------------- - -FINAL INSPECTION BY:..- Date--- ------ -- <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> r__ 145446 ATWOOD 12-S4 <br />