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APPLICATION FOR SANITATION PERMIT Permit No. ...:0_.3_....__.... <br /> ............. <br /> (Complete in Duplicate) Date Issued _.I <br /> _ J�_ 5 ` <br /> Application 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 co"mipllance.wifh County Ordinance No. 549. <br /> -------------------------------------------------------------------------- <br /> JOB ADDRESS AND L0CATIOl`4_ __­ —---------------_-_----- -_------------------ - <br /> Owner's Name__Z_` �-----01 ------------ <br /> -- ---•------------------------------- -- ---------7............. --------- Phone...--------------------------------- <br /> o <br /> Address_......---- —0... . % <br /> .... .. ---------5--- -----------------------------------------------------------------------------•----------------------------- <br /> Contractor's <br /> .....I----------------------------- <br /> Contractor's Name------ ZZ =---------------------------='------------------ •--------------.-------- <br /> Installation will serve: Residence] <br /> esidence 2_ Apartment House E] Commercial E] Trailer Court 0 Mofel 0 Other E] <br /> Number of living unifA1-__j.____ Number of bedrooms Number of baths . Lot size ------71)---1x._/ <br /> ----------------------- <br /> Motel 0-other <br /> ................................. <br /> Number of living units;.... Number of bedr6o�i,-.�'.--3.-.�.�..C7arbdge Grinder ... lot Size <br /> ivu- �aitu L luy�L�00111 <br /> _j �ravui Lj -�ai Li ��iay LUa M l_;iay,L_j r-%u e,� norcip <br /> Previous Application Made: Yes E] No X New Co'nsfrucfion: Yes 4 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-. ,Distance from nearest well-_; Distance from foundation--------__---------Material----------------------- - ----------------------- <br /> of C41parfments----------------- Size------------------------------__Li uid depth_------- ----------------Capacity----------------------- <br /> Disposal Field: Distance from nearest Weil----------:�_,-----Distance from foundation-------------------Distance to nearest lot line.___________--_-- <br /> M I imber of lines------------------------------- of each line--------_------ :-:--.----._.Width of trench.------___------------------------- <br /> �e�_ `�ype of Ater material------ --------- -----__ -Depth of'filter material------------------(---Total length___....----_____.__________-____________- \ <br /> See a e <br /> ength----------------------------------------- <br /> Seep6ge Pit: Distance to nearest well------//4,'.'-L'&_Disfance?fzm foundation___ --�0-------Distance P nearest lot line---- <br /> 9 Number "f p;f, ......I....... ---Lining maferial.-o-------- ----�_ < D*iamefer---..!!Y.-?,--'-.--Dpfh---.—.zA:�-- <br /> _ ------------ <br /> cesspool: Disfancelfrom nearest well-----------------Distance from foundation-----------:---------Lining material__._______._____________._-_-_.-_. <br /> �i <br /> F-1 Size: Diameter--------------------- ---------_ ----Depth---------------------------------------------- -----Liquid Capacity_ -------------------------gals. <br /> Privy: Distance from nearest We"'. ------­--------------------------------------Distance from nearest building___-________________-___________.____._._. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot Zine--------------------- ---------------------------------------------------I---------------------------------------------------------------------- <br /> Remodelingand/or repairin9��fdescribe):-------------------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------d-------------------------------------------------------------------------------------------------- ------------------------- -----------------------­---------------------- <br /> -------------------------------------------------------------------------------­-----------------------------------------:---------------w.____A-------------------------------------------------------------------------- <br /> --------------------------------------------------�1--------------------------7----------------------------------------------------------------------------------------------------------------------------------------------- - <br /> I hereby certify that I hive prepared this application and that the work will-be done;in with San Joaquin Coun <br /> ordinances, Stat laws, and Iles and regulations of the San Joaquin Local Health District. <br /> r <br /> (Signed)... ------ --- --------------------------%­------------­---------- -- --------(Owner and/or Contractor) <br /> ---- -- ---- <br /> ISI <br /> E ------------------: --------------{Title....... —---------------------------------------- <br /> (Plot plan, showing size of lot0ocafion of system in relation to wells, buildings,'etc., can.be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ar <br /> APPLICATION ACCEPTED BY-------------------------------r-- ---------------------------------------------- DATE------- <br /> ill, z�--------------------- ----------------- <br /> REVIEWEDBY------------------------ ------------------ --------- -------- ------------------- DATE----- <br /> BUILDING PERMIT ISSUED-1-----------------------­­-----�, <Z <br /> ---------------------------------------- --------- DATE----- ------- ----- <br /> Alterations and/or recomme-Aafions:---------------------- ------------------- --- ——------------------------ <br /> -- ------------ <br /> - -------------- ----- <br /> ---------- ----------------- <br /> --- ---- -- --------- <br /> -------------------------------------- -------- ----- --- - - - 7 ---------------------------------------------------------—-- -----­------------------ <br /> --- ---- ---- ---- ------------------­­­------------------------------------------------------ ------ <br /> ------------------------------------ ------- -- --­­---------------------- ------------------------- <br /> -------- --------------------------- -----------------------------------------------------------­------------------ <br /> ----------------------------------------------------------- ---------------­------ ------------------- --------- ------------------------------------------------ -------------­-------------------------------- <br /> FINAL INSPECTION BY:_J_'___. -------------------------- Date.---- ------------- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Streef 814 Norfh "C" Street <br /> Stockton, California Lodi, California Manfaca, California Tracy, California <br /> it <br /> 145446 ATWOOD <br /> 11. <br />