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-A I APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 3�. �-► i <br /> S <br /> Date Issued ______ <br /> 1 <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 AND LOCATION = "T RC - '�� <br /> Owner's Name----" �( � -- - - .. Phone-- -- <br /> Address _ % ...A1"._ ed -/� .�- ------------------- <br /> Contractor's Name -�'�� <� -- -------- -?-'x=.rf- -_ --------------- ------------------------_ Phone f? /�a ll-7 <br /> fInstallation will serve: Residence (''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _,/_'--_- Number of bedrooms -----I—Number of baths ---- Lot size --------&I A----?C __________________ <br /> Water Supply: Public systemmmunity system ❑ Private ❑ Depth to Water Table 40 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ck--•Ha-rdpan ❑ <br /> Previous Application Made: Yes ❑ No ®- '`N w Construction: Yes ["No ® "� <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` <br /> Septic Tank: * fDiltance from nearest well-----------------Distance from foundation-------- __-____--Material___-___-_-._-___--.__________--____--__... <br /> ��omparfmenl­s <br /> ---------- --------------Size--••-•-•-------•----------------Liquid depth---- -----------------.Capacity----------_------•-- <br /> Disposal Field: • D.istafnce from nearest well.-_.---- --------Distance from foundation-------------__.....Distance to nearest lot line---__-___________ <br /> ❑ umber•of lines----------------------_---------_Length of each line--------------------------_--Width of trench----------------------------------- <br /> Type filter material-------- Depth of filter material _-_..-----------------Total length--------------.______-_---_________--- <br /> Seepage Pit: Distance to nearest well --A/q,_�_Distance from foundption------ 05!_!_ .Distance to nearest lot <br /> ❑ .__ __ __Lining material___ Si e Riameter__--_Number of pits--------- <br /> ------------------ <br /> ------ <br /> ' -`Depth 2" <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------. .Lining material__... <br /> ❑ Size: Diameter------------------------- ---------.Depth------ ------------------------------------- ------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 /> -----------------------••-------------••-----------___-•---•-••-------•-------------__------_-_---._-----------------•-............................... ------------------------------------------------------- --•----- <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 regulations of the San Joaquin Local Health District. <br /> (Signed)--.. ------I--------- --------------------- -------------------------------------------(Orwner and/or Contractor) <br /> By: �'-- ..�— �_ -a i'.,- e ------(Title)-- ', -''�"' - -------------------- <br /> 6, <br /> (Plot <br /> - ----- -- <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- .- --------- - - - ---------------------------------- ------ DATEM----------------------------------------------------- <br /> REVIEWED BY---------------------------- ---• - --- . ----------------------------------------------------_ DATE-_ <br /> BUILDING PERMIT ISSUED---------------`---- ------------------------------------------------------------ ----------------- DATE------ ----- - <br /> Alterations and/or recommendations:_-__�_:_____..---------------------------- <br /> ------- --------------------------------------- <br /> ----------------------- <br /> ----n. <br /> -------------f�� -----------� '---'-c"'�------------------ --------------- <br /> ------------------------------ ---------- ----- <br /> - - ---------- ------------------------------------------- -------------------- ------------ --------------------- <br /> �S <br /> FINAL INSPECTION BY: f 7�--- <br /> --------------------------------------------------------- Date------. --------- ------ ---------------------------------------------- <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 />