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/'11CATION FOR SANITATION PERf7� \j Permit ..... . <br /> (Complete in Duplicate) if <br /> Date Issued ----*_)k--- <br /> A�plica-�ion is hereby made to the San Joaquin Local Health District for a permit to constru#f an install the,W?jk hytein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ANATION------ ...... <br /> go.- 7----- -------------------------- <br /> Owner's Name.------- ------------------- ------------------------------- - -- ----- ------- Phone--'--'----'-----•- ----------- <br /> -- ----------------------------------- -------- ----------- <br /> Address...... ----------------­----- ------ ---- ------------------------ <br /> -------- -------------- -------_ -------- 17 <br /> Contractor's Name--- ------ -------- I-------- ------------ Phone---,A---- <br /> Installation will serve: Residence [ 'ApartmeJ House [] Commercial El Trailer Court [-] Motel E] Other L] <br /> Number of living units: ___t. Number of bedrooms .-I,.Number of baths .-/--- Lot size ------2-v---- —--------------------------- <br /> Wafer Supply: Public system [I Community system [-I Private Ed-A31-epth to Water Table ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F1, Clay Loam El Clay [j Adobe M,-Kardpan E] <br /> Previous Application Made: Yes E] No E? New Construction: Yes No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted blitsewer is available within 200 feet.) <br /> P <br /> ------------- - <br /> Se is `______-...Mate.ia <br /> S ' T nk:9 Distance from nearest Distance from foundation-- <br /> No, of compartments----."--- <br /> Liquid depth.,42.1__---------Capacity.44 OFV.-�4 <br /> ouw <br /> Disposal well. <br /> ield: Distance from nearest wel ..... a <br /> Dis(ac7?, ou afion----1,0_7.Distance to nearest lot line---------e!�:_ <br /> ------------Width of french- <br /> Number oi� lines----------------- -Length of each --------------- <br /> or filter Ma <br /> Type T teriaI1..V.__.Kf__)----Depth of filter material---- .... Total length--------1_16----------------------- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation________________.._Distance to nearest lot line_._____.______._ <br /> El Number of pits------------- -- -----Lining material------- ----- -------- Size: Diameter-------------- --------Depth_------------------------------- <br /> -orn nearest well_________________Distance from foundation.__._.__....______.Lining Lining material----------------- -- <br /> Cesspool: Distance from ---------------- <br /> ❑ Size; Diameter._....- - ----- ---Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building---------------------------------------- <br /> ElDistance to nearest lot line--------------------------------------------------------------------------------- -------- ---------------------------------------------- <br /> Remodelingand/or repairing (describe):----------------------- -------------- -------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------1------------------------------------------------------------ ----------------------------------------------------- <br /> - ------------------------------------------------------------------------------------------------------------------------------------------ ------I-------------- <br /> -------------------------------- --- --------------------------------------------------------- ------------------------ -------------------------------------------------------- --------------- 1--------­ ----- - <br /> F.. .......... ----------------------- <br /> -- - <br /> I hereby certify that I have 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 Local Health District. <br /> ------------------------------------------------------------------------------- ----------------------- Contractor) <br /> (Signed) <br /> By:------------------------------------------------------------------------- ------ -- (Title)--- --------------- <br /> (Plot plan, showing size of lot, location of system in relap n to wells, 6uildin4s, etc., can be placed on reverse side). <br /> y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------------------- --------------------------------------- DATE------ +_-Z-------------- <br /> REVIEWED BY------------------ --------------------------------------- ------ --- --- <br /> ------------ ----. DATE---------------- ------f?-.-------- ------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------•------------------ <br /> Alterations <br /> ATE_-----------------------------Alterations and/or recommendations:---' ------ -- ----------------- ------------------------------------------------------------------------------ <br /> �— <br /> ------ -- - - -------------- ---------- ----------I----------------------------------------- <br /> ---------------------------- <br /> ------------------------------ ------------------------------------------------ ------ --------------------------------------------------------------------------------------------------- ---------------------------------- <br /> ---------------------------------------------------------------------*--------------------- ---------------------------------------------------------------------------- <br /> -----------I- -----------------------------------------­------------ - ------ - ---- --------------------- ------------------------------------------ ------------- ------ -------- - - - - - - --- <br /> F--- ---------------------------------------------- -- Z <br /> LA f <br /> N BY:____LP�2� Date.............. -------- ------- --------------- --------------------- -- ---- <br /> FINAL INSPECTION -------------------- ------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Straef 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 />