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APPLICATION FOR SANITATION PERMIT Permit No. _.__l... . <br /> I (Complete in Duplicate) <br /> Date Issued ---- ­---/ <br /> a <br /> Applica+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. ble3-2-6-0"- fb <br /> t.3 Zo 4 � R ClG <br /> JOB ADDRESS A9D LOCATION_. <br /> Owner's Na _l_t U0 a. ic --e it----------- -------r'-------------- ----- ----------------- ------------------ Phone--/-------------------------------- <br /> Address... �' I ll.... ------ hl}L�A t <br /> ---_---------------•-----•-----•-----------------•---------•-------••-- -----------------­---------- <br /> .7 <br /> Contractor's Name-'-_ • "fe4___.Sev�_PnC_ � ---------------------- ------------------------------------_ Phone----------------•------------------ <br /> ---- ��, <br /> Installation will serve: Residence Apartment House Commercial Trailer Court Motel [-] Other [IL?/ F1 [3 ❑ <br /> Number of living units: __ <br /> ____ Number of bedrooms 3-_._ Number of baths J____ Lot size ._- ____QCrQe_S______________________.____ <br /> H <br /> 14 Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table -------- ft. <br /> WCharacter of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam E] Clay Loam [I Clay [j Adobe Hardpan E] <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f - <br /> I Septic Tank: Distance from nearesT well. __Q______Distance rom f ndation__1 ----.------,Mater al`.______"_____________________ <br /> /,� ` <br /> a d No. of compartments....._pZ.__�_"__!-. Size__ _�{ ------------Liquid deptli____rT%-"__.------.-CapacitY <br /> {�9 Dispas I Field: Distance from nearest well---_a.�-1....Distance from foundation___f_�___ --------Distance to nearest lot lineJAe-____. � <br /> �_ ( Number of lines---.-----�---- ------------------Length of each line-----1;....--..............Width of trench---- ...................-- W <br /> r ,. <br /> Type of filter material lv.f n'�--.---Depth of filter material____ _ _____________Total length___.____'_-S__11______.________.____`.__ � <br /> i 5eepa e Pit: Distance to nearest wel!_.f�d---_._ Distance from ,foundation___�,)-�_______.Distlnce to nearest lot ii�e__���__.-_-_ <br /> Number of pits------- --------------Lining material C`COAG !e e-----Size: Diameter____,-_I------------Depth---�----------------------- N <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> Size: Diameter ----Depth---------------------------------------------------Liquid Capacity- --------------------------gals. <br /> f Privy- Distance from nearest well---.------..........._-----_----:---.------:----Distance from nearest building------------------------------------------- <br /> F1 <br /> ________.__ ________.______--__.____._. <br /> ❑ Distance to nearest lot line. --------------------- ----------i-------- ---------------------------------------- •----------------------- <br /> 1 Remodeling and/or repairing (descril,e):----------------------------------------------------------------------------------------------------------•-------------------------------•------------•---•------------------------•------ <br /> ----------------------- <br /> ---------------------------------------•-------------------------- <br /> -------------------- <br /> --------- ---------------------- ---------------------------------------•------------••-----------•---------•- ----•----------------------------------------- ----------------------------------------•-------------- <br /> I hereby cert' that I h prepared his pplication ano that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta ws, and u s and regulati ns of the Sa oaquin Local Health District. <br /> -- __ _ her and/or Contractor) <br /> { j [Signed]------ .. ---- <br /> __ _ _[Ow d/o <br /> 5 By:-------- ----- --------•--------•------------------ - ------- -----------------------------------------------------------(Title) <br /> (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be p ced on reverse side(. <br /> a� <br /> FOR DEPARTMENT USE ONLY <br /> a - <br /> APPLICATION ACCEPTED BY----- ------- ----- ---------- --------------- <br /> ------------------ DATE-SL— <br /> -- - <br /> i REVIEWED BY--------------------------------- <br /> --- -- ----- --------------------------------- ---------------------------------- DATE------4--------------------------------------•------------ <br /> BUILDINGPERMIT ISSUED----------------- ---------------------------------------------------------- DATE RCS <br /> Alterations and/or recommendations---- ---------- --------------- --------------------------------------------------------------- <br /> �5----------- <br /> • - ----•----------------------------------------------------------------------------- <br /> ---------------- <br /> •---- <br /> ------------------------ ---- <br /> - <br /> ------- <br /> --•--------- ! <br /> ------------- <br /> ----------------------- - <br /> --------------------- <br /> ---------------- ------------ - ----------- <br /> -- ------ - ------- Date <br /> FINAL INSPECTION BY-- ----- -------------- --- --- -- - -- -- � *��- --c;(�--�----� ------------ <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E30 South American Street <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> S+oak+on, California <br /> Lodi, California Manteca, California Tracy, California <br /> Es-9-2M 145446 ATWOOD 12.54 <br />