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\1' <br /> APPLICATION FOR SANITATION PERMIT Permit Njo. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica4ion 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 N 549 <br /> !I <br /> N n ---- ----- -------------------------------- <br /> I - ------------ ------------------------------------------------- <br /> JOB ADDRESS ANDK:ATp---------------- ---- ---- <br /> Owner's Name____________ -----j�------- 4A �$_d---------:--------------------------------------------------------------------------- ----------- Phone----------------------_ <br /> Address------------------4-It- 7. <br /> ,- ---­­---------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name----- at�---------------------- --------------------------------------------------------------- Phone------------------------------- <br /> Installation will serve- Residence A--;rplItment-House E] ' Commercial ❑> Trailer Court L]. Motel [3 Other L] <br /> Number of living units: Number of bedrooms --- <br /> Number of baths -!/-- Lot size ------------------------ ----------------- <br /> % <br /> Water Supply: Public sysfer:n Community system [] .. Priva-te,,E] Depth to Water Table 457ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F Sandy Loam E .Clay Loam EClay EAdobe Er- iar' <br /> dpan E] <br /> Previous Application Made: 'Yes E] No � New Construction: Yes F] 'No �+ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available withiri-200 feet.) <br /> a. 1, <br /> Tank: Distance from nearest well_________________Distance from 16undation-------------------Material------------------------------------ ----------- <br /> Nc�. of compartments----------- --------------Size------------- ---- -------- ---Liquid depth--------------------------Capacity---------------------- <br /> �Disp <br /> epth--------------------------Capacity----------------------- <br /> Disp .I (iield: Disfance'�!Trom nearest well_________________Distance from foundation.--------------_---.Distance to nearest lot line.--..--_---_-__. <br /> Number'of <br /> ine-------_-------- <br /> Nurnber'oir lines-----------------------------------Length of each line----------_------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter'mat6rial-------------- --------Total length___.____..__-_.___________-________--_.__- <br /> Af <br /> Distance nearest )kMz��D i 45CFTj*i to nearest lot ---------------- <br /> Seepage Pit: rest welL Di �nce from Depth---- line__Z� <br /> Number'of p;ts. .../-------------Lining materialji?A� ------------------- <br /> �d�flon 1-inin'gmaterial------------- --------------- <br /> Qxsti <br /> Cesspool: Distance <br /> ' from nearest well_________________ i r6rn f,,n a --- <br /> El Size: Diameter---- - ---------- .....--------------Depth--------. ------------------------------ -- ---Liquid Capacity- .-------------------------gals. <br /> v <br /> Privy: Distance from nearest weil------------------------ ---------- -------------Distance from nearest building__._-____---_-----------.__ - <br /> ❑ Distance'.to nearest lot Iine ----------- <br /> ------------------- - -- - - - -- ---------------­------------------------------------------------------------------------- <br /> �j--------------- <br /> - <br /> Remodeling and/or repairing (describe):----------- ------- ------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> _____________._.____.___-._--..______.-____-____:_I <br /> ______-__-_____-__---•____.___-___-__-___________--_-_I--------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------1--------------------------- --------- <br /> 7--------------------------------- ------------------------ ---------------- <br /> I hereby certify that I 6ve 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 Loc Health District. <br /> ... . . ::(Gk"Yer-e"4�4r Contractor) <br /> ----- ----- --------------------------- <br /> (Signed).............- -1 4, -- ---- - - ------- <br /> --------------- <br /> By:----------------- ------------------------------ --------(Title)- <br /> (Plot plan. showing size of location of system in relation to wells, buildings, etc., can be pi:.K.?n reverprside). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED�1BY------------- ------------ ----- ------------------------------------------------------- DATE ----------- ------------------------- <br /> REVIEWEDBY-----------------------:-------------------------------- ---- - __­---------------------------------------------- --------- DATE------ ------------------­­----------------------- <br /> BUILDINGPERMIT ISSUEDJ---------------------- ------ - .... ..­ --------------- ---- ----------------------------- DATE------------- ----------------------------- <br /> Alferaf* P"djor wromrrja� , ------------------------------------------------------------I............ ------------------------ <br /> ft . t -------------- -- - ------ ---- <br /> ---------- ---- ------ - - ------------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> '---------•---.----•--------w-------------- - ----- ---- ---- ------ ------- ----------------------------- --------------------------------------11------- <br /> -------------------------------------- <br /> ----------------------------------------- -- ---------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- ---------- --------------- --------------------------------------------------------­­_­ ------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:. ----- -F4-—----------------- --------------------- Date--- . -------------- ------------------- --------- <br /> SAN JOA9UIN'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 /> E5-9 145446 ATWOOD <br />