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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> gA <br /> plica-liton is hereby made to the San Joaquin Local Health District for a permit to f f <br /> is application is made in compliance with County Ordinanc 549 7ons ruc and install the work herein described. <br /> JOB ADDRESS AN LOCATION <br /> , --- - ---- ---- 5—------- <br /> W *r, -- -- - - - -------------- - <br /> Owner's Name---- - ----------------I--------------------------------------- <br /> ----------------------------------- <br /> _ ------ <br /> Address .......... Phone--------------- <br /> 4.6 -------- ---- - -- -- - ------ <br /> ------------------•-••-------••-------------------- <br /> -------------------_._------------------------ I--------------------------- <br /> Contractor's Name- <br /> Installation will'serve: Residence 9­yk�rnenf House [] Commercial El Trailer Court E] Motel 0 Other L] <br /> Number of living units: _/_ Number of bedrooms Number of baths Lot size -- __-_A <br /> Water Supply; Public system 4�_ Cmunify system E] Private El Depth to Water Table ft- <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam 11 Clay Loam El Clay'Ej Adobe 6—Ma-r7pan Ej_ <br /> Previous Application Made: Yes El No 6--New Construction: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p'ermiffed if public sewer is available within 200 feet.) <br /> Tan : I <br /> Sept'K_ Distance from nearest well.-___"- Distance from foundation <br /> No. of compartments---------- --- --- ...Material----------------- ---------------- ------------ <br /> -- -- -----Size--------------------------------Liquid depth------ ------------Capacity---------------------- <br /> )$p sat Field: Distance from nearest well- --------- --Distance from foundation------ <br /> Number or lines-" _!----------------------_------Length of each line------------------------------Distance to nearest lot fine____--___-_"_____ <br /> Type of filter material--" - ----------------Depth of filter material---.-----.- of trench----------------------------- <br /> Seepige Pit: Dlsfa_nce to nearest well,09$4j'�_ __Disfance_�m fo --------Total length------------------------------------------ <br /> Number of pits__::7/ dation--,,,-/ Disf6nce,fo nearest lot line---- <br /> ---Lining mate ....Size: Diameter_1._R? 1-------Depfh---2j- <br /> 0 __o�----------------- <br /> Cessp <br /> Cesspool: Distance from nearest well <br /> S ize:,D ia Fne'te-r--. -----------------Distance from foundation----------------­rLining material_".._ -"-".-_---___--___----------- <br /> - <br /> ------- -_M`------Depth: <br /> - -------- ;� <br /> Privy: Distance from nearest well ------------------------I----Liquid Capacity ----- --------- -------gals. <br /> ------ ---------------------------------------Distance from nearest building---------------------- --------------- <br /> Distance to nearest lot line <br /> --- <br /> Remodeling and/or repairing (describe):-------------- ---_--- <br /> - <br /> --------------------------------------------- ------------ -----------------------------------------------------------I--------------------------------------------------------------------------------------------------- <br /> -----------------­---------- ------------------------- <br /> -----I- <br /> ----------------------------------------------------------------------------------------------------­_­--------------------------------------------- <br /> ---------------------------------------------------------------- ------------------------------------------------------------------------------I----------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and thaffhe work will be done in accordance with San Joaquin County <br /> ordinances,, S fe I ws, SAd rulesand regulations of the San Joaquin Local Health District. <br /> (Signed)---- - - ------- <br /> B : ------ ----------------------------------------------------------------­-1Q4mver-&fteVm Contractor) <br /> y ------ <br /> ------ ----- - ---- ... .............................................. ..... .(Tif le)---_-------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc can be-placed an reverse side). ----------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---... <br /> DATE <br /> REVIEWED BY--- -- -----—---------------- <br /> -------------------------------------------------I----------------- DATE <br /> BUILDING PERMIT ISSUED ---------------------------------- <br /> ---------------------------------------------------------- DATE---- <br /> --------------- ----------------------- <br /> Alterations and/or recommendations:_ _NS . I <br /> ------------ --- -------------- <br /> --- -- ------------ ---- --------------------------------- ------- <br /> ---­----------------------- ---------­-------------- <br /> --------------- ---- - -------------------- <br /> ------------------------------------------------------------------ <br /> ----------------------------------- --------------------------------------- <br /> - <br /> ----------------------- - ---------- ---------------------------------------------------------------------- --------- --------I------ <br /> ------- --- ----------------- ­----------------------- ------------------- ------------------------------------------------ <br /> FINAL ;INSPECTION BY:... <br /> --------------------- Date----_- <br /> --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> Stockton, California Lodi, California Man4bca, California 814 North "C" Street <br /> Tracy, California <br /> ES-9-2M 145446 ATWOOD 12-54 <br />