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APPLICATION FOR SANITATION PERMIT Permit No. .--;24/- <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica-lion is hereby made to the San Joaquin Lgc4l H9No. <br /> ealth istricf perm' to construct and install the work herein described. <br /> This application is made in compliance with Cd <br /> - ' <br /> 0�111 5 <br /> JOB ADDRESS AND LOCATION---- <br /> ---------- <br /> Owner's Name--•------ ------------------ ----------------------------------------- <br /> Phon <br /> Address--------•-------•-------- ----------------- -------- -------------------------- <br /> 4K------------- <br /> Contractor's Name________._______."-- -------------------------------- ------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------- Phone-,----------- <br /> Installation will serve: Residence [N--Apartment House 0 Commercial El Trailer Court E] Motel E] Other <br /> ❑ <br /> Number of living units: _J__ Number of beclr.00ms,__;�7 Number of baths j---- Lot size __j '. <br /> Lj.__Y <br /> Wafer Supply: Public system 21_�C_Ommunify system E] Private F1 Depth to Water Table --------------------------- <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe�Harclpan E] <br /> Previous Application Made: YesEl� No � New Construction: Yes�x No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well/to------Distance fro rfounc1afion__/4_ <br /> �y <br /> - --------- - -- <br /> P C a pa 6 fy. <br /> t te— Size---$,,,- q---Liquid Oe_p�.h, feria <br /> No. of compartments------- <br /> --- ------- <br /> 44 Distance from founclatioralp <br /> Disposal Field: Distance from nearest _7�?�ance to nearest ]of lin —AV_xAj <br /> y _r------- a,_#------------- <br /> Number of lines f each line_ 77W Width of french---- <br /> -------- Length o <br /> ----------------- <br /> Type� r filter materia bPfh of filter material-------- -- <br /> ---------- <br /> Seepage Pit: F 91-------Total length--------------k2t 0 <br /> Distance to nearest well-------------------.--Disfance from foundation____._______ -------------- <br /> U- ber Of P;fs------------------- -- nng material________._-____.Lii --------Distance to nearest lot line---- <br /> .E1 N "m ...Size: Diameter_.--___:__--------------Depth_ ------------ ------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- --------------Lining material_______________________-------------I--- <br /> 0 Size: Diameter---- -------- --------- ........Depth--- - ------------ <br /> -------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.._._-__"-.---"--___ 4 <br /> EJ Distance to nearest lot line-----------------------------------------------------------------Distance from ne6rest building--------------------------------- ........ <br /> I --------------------!----------11----------------------------------------------------------------------- -------------- <br /> Remodeling and/or repairing [describe):_.___._____.____----_ <br /> -------------------- ---------------------------------------- <br /> ----------------------------------------------------------------;---------------------------- -------------------------------------------------------------------- ----------------------- ---------------- <br /> ------------------------------- ------------------------------- --------- ---------------- <br /> -------------- --------- <br /> ----------------------------------------------------------------- ------------------------------------------------ <br /> ------------------------------ -------------------------- ---•---------•-•----------------------•-------- <br /> ----------------------- ------- <br /> --------------I--------------------------------- --------------------------------------------------------------------------------- <br /> I hereby cer+ify.fhat I hive prepared this applicationandthat the work will be done in accordance - ------------------------------ <br /> ordinances, State- ws, and rules an gulations of th dance with San Joaquin County <br /> e.San Joaquin Local Health District. <br /> (Signed)---------------- ---- .. --------- <br /> -------- ---------------- --- -------- <br /> ----------------••-------------------------------------------------(Owner and/or Contractor) <br /> ---------­-------0 <br /> By:.........T4 - <br /> ---**--------*-------------------------------------------------------------- -----..{Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, locatioW of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___K <br /> REVIEWEDBY -------------------------------- DATC�-- ---------------------------------- ----------------- <br /> BUILDING PERMIT ISSUED---------- ------------------------------------------------------------------------------- DATE__nL -- --------------------------------------------- <br /> Alterations and/or recommendations:_------------------------- ------------------------------------------I----------------------------------- DATE--- ------------------------------- ------------_ <br /> - ----------------------------------------------------- ------- ------------------------------------------------ <br /> ,V <br /> --------------------------------------------------------------------------------- --------- -----------------------------------------------------I--------------------------------------------------------------------------- <br /> ------------------------------------------------------------------- -------------------r---------- ......................I------------------------------------------------------------------------- ------------------------ <br /> ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------ ---------­-------- -------------------- -------I--------------------------- -------------------------------------------------- ----------------------------------------------------------- <br /> FINAL INSPECTION ---------------------------------- Date.- <br /> -61 ----------------- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfrest 300 West Oak Street 132 Sycamore Street <br /> Stockton, California 814 North "C" Street <br /> Lodi, California Manteca, California Tracy, California <br /> FE-9-2m 145446 ATWOUD 12-54 <br />