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APPLICATION FOR SANITATION PERMIT Permit No.-.._2111.. <br /> (Complete <br /> o. 1-2111L.(Complete in Duplicate) <br /> Date Issued <br /> plica+ion 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 /> JOB ADDRESS AND LOCATION.. x <br /> 1;1? --- /1------------- ----- --- -------- --------------------------------- <br /> -t;;?,- ------------ <br /> Owner's Name---------- -------------10-w 00 <br /> ------ <br /> --------------------------------------------- --------- - ---------------------------- ---------..........--- <br /> .. Phone------------------------------------ <br /> ----------------------------------•---------- <br /> Contractor's Name----- ­-�-- --------------------------------------------- Phone---------------------------------- c. <br /> - <br /> Installation will serve: Residence Apartment House E] Comm4rci6l [j Trailer Court E] Motel [] Other 0 <br /> Number of living units: r <br /> /--- Number of bedrooms ­';�Nrimber of baths /._--_ Lot size -------------------- ----- <br /> Water Supply: Public"system —community system E] Private E] Depth to Water Table ft. <br /> Character <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam E] Clay [] Adobe Hardpan El <br /> Previous Application Made: Yes J-]I No JE_ New Construction: Yes R]_ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p6rmiffed if public sewer is available within 200 feet.) <br /> t <br /> Septic Tank: Distance from nearest well------------------Distance from foundation---------------- Material-------------------------------------------------- <br /> El 4 4 <br /> Notjaf compartments----- ------------ -----Size----­------------------- -----Liquid depth--------------- ---------Capacity.. ------ <br /> Disposal Field:, QjsWce from nearest well____.___--"- Distance from foundation--------------------Distance to nearest lot line----I——------- <br /> F-1 u er of lines-----------------------------------Length of each line--------------.---------------Width of french--------------- ------------------ <br /> Type of filter material-_---"... ----------------Depth of filter material-------------- ---Total length-._--._-..._.-...._-..--------------...- <br /> Seepage <br /> ength------------------------------------------ <br /> Seepage Pit: Distance to nearest well.- A�` i­ ­sfance frpm foundation--lzI. .. ..... Distance fg nearest lot line---Zo�Z. <br /> Number of pits-J.--,/------------Lining material---P 9.C-JrSize: Diameter--- ----Depth-­,5L-!r�-------------- <br /> Cesspool; Distance from nearest well.................Distance from foundation- .-----------------Lining material--___--.------...__.____----------- Q t <br /> ❑ Size: <br /> aterial-- --------------------------------- <br /> Size: Diameter---7---------------------------------------------- ----------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well________________ ---- ------- ---------Distance from nearest building--..-....___--.----------- -_-----------. <br /> El Distance to nearest lot line---------- ------------------ ----------------------------------------- ------------------------------------------- <br /> ( <br /> Remodeling and/or repairing (describe]:--------------------- ----------------------------------------------------------•----------•---•-- ---------------------------------------------------- <br /> ...................................:------------------------ ----------------------------------------------------------------------*­---------------------------------11------1*1­­------------------I------------- <br /> ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ <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 /> ordinancesSlaws,laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signedly. --------- .....1�p------ -- ----------------(Owner and/or Contractor] <br /> ----- -- ------------------------------------- <br /> By:--- -t—p- - - ?:> 4 �-, t-- � �,o <br /> ........ -------------------------------(Title)...........41;5ikA- ------------ --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on r/velse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----_ ------------ ------- ---------------------------------------- DATE...--.. ---------- <br /> ::---::- - -- ------------------------------------------------------------- DATE--- <br /> REVIEWED BY-------•---------------------------- ------ <br /> BUILDING PERMIT ISSUED--------------I------------------ -- ----­----------A---------------------------------------- DATE------ ------ ...... <br /> Alterations and/or recorn mendafions- - --------------- ----------------------------------------------------- - --- <br /> --- <br /> ­- I <br /> *----------------------:------ - - - ----------- 91. <br /> r . <br /> -------------- --------------------- - ------------- --------------A <br /> -------------------------- ------ -------------------------------------- <br /> ­---------------------- ....... ---- - ------- --------- ---- z ------ <br /> ------------------------------ <br /> V14( --- <br /> --------- - ------------- ----------------------------------- ----------------------------------- --------------- ------------------------------------------------------------------------- <br /> -------------------------------------------------------------- ------------ ----- - ---------- ----------------------------------------------------:------------------------------------I--------------------- <br /> ------ - - Date---...--------------------------FINAL INSPECTION BY:. -- - <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 /> 145446 ATWOOD <br />