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APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> (Complete in Duplicate) <br /> Date.issued --- <br /> Applicakion 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 /> tV------------------------- <br /> JOB ADDRESS AND LOCATION------ ------ qS <br /> --- --------------------------------------------- <br /> Owner's Name_.__----.---Z—A_C�_t ------------- - - - -------- -------- ....... Phone----------------------------------- <br /> Address-.--------_.......... --------------------------------- --------..........I------------------------------ ------------------------------------------------------- <br /> Contractor's Name--- <br /> --------------•------- <br /> -------------*-------- - ------------------------------------ ---------------- Phone//0747��7 <br /> Installation will serve: Residence $. Apartment House E] Commercial E] Trailer Court E] Motel Ej Other E] <br /> Number of living units: I---- Number of bedrooms Number of baths __/---- Lot size --- —---------------------- <br /> Water Supply: Public system p Community system [-] Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Loam Ej Clay Loam El Clay El Adobe ' Hardpan El <br /> Previous Application Made: Yes El No 756 New Construction. Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- f4a Distance from nearest well_.;______________Distance from foundation--------------------Material------------------------------------------------- <br /> El Alp No. of compartmenIs--------------------------Size--------------------------------Liquid depth-------------------------.Capacity-••------------------- <br /> Ar, I <br /> Disposal Field: Distance from nearest 4ell./.409 -Distance from foundafion,__/Z......_Distance to nearest lot 1inp___-5......... <br /> L <br /> Number of lines-_.0-H,�5 ---_--________--Length of each line------;_1�7 �"(_,�.JWiclth of trench-.-,Z4---/-- ------------------ <br /> A` A:.t?,..-Depfh of filter material-----?�?�W_Total length---------lq-'- <br /> Type of filter material.- -- ----------------------- <br /> Seepage Pit: Distance to nearest well---/VIA( --Distance from foundation----157------------Distance to nearest lot line_ <br /> 0 Number of pitsOMC-------- Lining mate ria 1_10t�V<o......Size: Diamefer___3311--------- <br /> Cesspool: Distance from nearest well___---_"---_-.._-Distance from foundation___________________ Lining material------------------------------------- <br /> F1 Size: Diameter--------------- ------Depth----------------------------- -------------- ---Liquid Capacity-.------------------_------gals. <br /> Privy: Distance from nearest well-__._"....................._-_...._---.._-.-__--Distance from nearest building"-""."_""_-____-__-__________.._--____-_. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot line----------------- ------------------------------- --------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe]:---------- --------------------------------------------------------------------------------------------------------- ------------------------------ <br /> ---------------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------- <br /> ------------------­-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- ----------------------------------------------------------------__.................­--------------------------------------------------------------- -- - <br /> I hereby certify fh'af) have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State 1as, nd rules.and rdgulations of the San Joaquin Local Health District. <br /> p4l <br /> (Signed)----------------- ----- ----------------&4. .......... ....................... ----{Ownerand/or Contractor) <br /> By:----------- ------------------------ ----------�17------- ------(Title)------- ---------------- <br /> (Plot plan, showing size of lot, cation of system in relation to well , gs, etc.. can be placVd on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ........------------------------------------------------------------------------------------- DATE!,-Q--.—--------------------------------------------------- <br /> REVIEWEDBY---------------------------------- ---- ------------------------------------------------------------------------------------ DATE <br /> -------------------- <br /> BUILDING PERMIT ISSUED---•-- --------------------------------------------- ----------------------- ---------- DATE-- <br /> Alterations and/or recommendations:._._-_--_"........ ......................... ------------------------------------------------------------------1%--------------------------------------------- <br /> ------------------ --------------------------------------------------------- --------------------- -----------------I------------------------------------------------------------------------ ......I----------------------- <br /> ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ---------- -------------­-------- ---------------------------------- --------I------------------------------------------------------------------------------------------------------ <br /> - --------------------------------------- ------------------- -------- ------------------------ ----------------------------------- <br /> FINAL INSPECTION BY:-. -- -----------------------------------------------------------------Date. - ------ ------- ------­------��----------------------------------- <br /> SAN <br /> ------- ------------------------------------ <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 />