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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> Date Issued --- ----------------- <br /> Applica4ion is hereby made to the San Joaquin Loca: Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance wifk,Counfy Ordinance No. 549. 0 -0 <br /> JOB ADDRESS AA\ID LO ATI ead%Pk1 .... .... ... ----------- ------ ! ----- <br /> 5---------- - -----Owner's Name..._- _- <br /> t--------- --------------------------------- --- ---------------------------------------- Phone__.. --------------------------- <br /> Address—------------- -- --------- ----------- --- --- - --------------------------------------------------------------­­--------------------------------- <br /> Contractor's Name----------------4 - •--- •------------------------------------------------------- -------------------------------------------------*----- Phone,—------- <br /> Installation will serve: Residence Apartment House E] Commercial Ej Trailer Court Motel [] Other JDir <br /> I !� 0 0 94 .4. <br /> Number of living units: -------- umber of bedrooms ­4�- Number of baths -------- Lot siz <br /> ------------ <br /> Wafer Supply: Public system Cj Community system [:1 Private Depth to Water Tal-------- it. <br /> M <br /> 1dCharacter of soil to a depth f 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam Lj Clay E-] Adobe [W Hardpan E] <br /> El <br /> Previous Application Made: Nes E]- No � New Construction: Yes Y No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> A <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------------------------------------ --------11 - <br /> No. of c6partments.................... -----Size--------------------------------Liq-u'id depth.-. - -Capacity_____-______________ 7, <br /> Disposal Field: Distance'from nearest we1- Distance from foundation___I---------------Distance to nearest lot line_____--_._____ <br /> Number <br /> ine------------ <br /> Number of lines-----------------------------------Length of each line-------------- -Width of trench---------------------- ---------- <br /> Type of filter material-------------------------Dep thfof filter'material___,-__,.--------------Total length---------------------------------------I <br /> Seepag Pit. Distance <br /> [to nearest well----------------------Distance' from foundation____________________Distance to nearest lot line______________ <br /> Number 'of pits----------------------Lining aterial-----------------------Size: Diameter—.-------------------Depth--------------------------------1 (Z5 <br /> qj <br /> Cesspool: Distance from ne rfst well Lining <br /> from foundation----1-0-------- Lining material-----—xeKsL- L <br /> -------------------------------- <br /> -----gals.. <br /> . 7 7s-o---- <br /> Size: Dia�mefer-AWIX# ��-ADept�hj!-------- Liquid Ca pac ity------ <br /> ------------------- <br /> 7 <br /> F ri --tfirolm! I------ rest building----------------------------------------- J <br /> Privy: • Disfa'nce --- -- ----- --------------- .............ttane fro, ea <br /> El Distance')to nearest lot line-------------------------------------------------. <br /> - - ---------------------- ---------------------------------- <br /> ------------------------------------ <br /> Remodelingi and or repairing (describe)- 94;� ------ ------ -- --- ---------- <br /> .. ---------------­----- ---------------------------- <br /> -- ------------------------------------------ <br /> - ------- --- --- <br /> -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------- ------------!!�- ------------------ ----- <br /> ------------------------------------ ------------ -------------------I--------------------------------------------------------------------------------------------------------------------------------------------61 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------ ------ <br /> (Signed)----- -------- ---- --- ------- --------- ------------- - ---------------------------------------------------------- -------------(Owner and/or Contractor) <br /> By:------- ------------------- - --------------------------------------------(Title)------------------------------------------- - ----------------- <br /> (Plot plan, showing size of lot, location f sys; m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------- ............. ------ ---- -- <br /> REVIEWEDBY--------- ----------------------------- ---------------------------------------- DATE <br /> S--S-J-E-b- I-------- - -------------------------------- <br /> jo <br /> BUILDING PERMIT I ----------- --- ---- ----- -------------- ----- -------.- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:___------- -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Il <br /> -------------------------------------------------11----------------------- ---- ---------- ----- - -- --------I---------------------------------------------------------------------------------------------------------- <br /> ----------I-------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------.......­ <br /> ---------------------------------------- -------- ----------------------- --- -------------------------------------------------------------------------------------------------------------I- -------- ----------------------- <br /> ------------------------------------------------- ----------- ----- ... ... .... ......I----- ---------------------------------------------- --------------- --- ----------------- -------------------------------- <br /> FINAL INSPECTION BY:-- ---- -- --- --- --- ---- --- ----- ---- Date--- - ------- ---------------- <br /> I� Ii SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street ill, 300 West Oak Sfrea+ 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California kf <br /> ES-9-2M 145446 ATWOOD 12-54 <br />