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APPLICATION FOR SANITATION PERMIT Permit No. ...731-P... <br /> (Complete in Duplicate) Date Issued ._ /S/S _-- <br /> Applica-lion 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 Ordinp(e No. 549. <br /> 41�------------------------------------------------------------------ <br /> JOB ADDRESS D L A) <br /> - ----- --------- -- <br /> ------ _41 --------------------------- ------------------- -------------- Phone------------------------------------ <br /> Owner's ---- -------------------------------------------------------------------------------------­....... <br /> Name---- -- ---t-- ---- --- --------- <br /> Address...._3------A_ ------ <br /> (0 <br /> -------------------- Phone.---------------------------------- <br /> Contractors Name— - ---------I-------- ------------ - ----------------------- ----------------- -------------------- <br /> Installation will serve. Residence Apartment House E] Commercial [:] Trailer Court El Mot q 0 Other <br /> ❑ <br /> Number of living units: -1---- Number of bedrooms _Z__ Number f baths -1--.-- Lot size ---------------------- <br /> Water Supply: Public system F] Community system 0 Private VE Depth to Water Table _.------ ft. <br /> Character of soil to a depth of 3 feet: Sand F1 Gravel El Sandy Loam El Clay Loam 0 Clay 0 Adobe 2e-*Hardpan 0 <br /> Previous Application Made: Yes 0 Construction: Yes M"N, [:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if Dublic sewer available within 200 feet) <br /> Septic nk: Distance from nearest welo ang f fouiaplption/.0_1a;Wer.a�__)---- 4-------------- --------............. <br /> '-Si <br /> e )Tr Capacity----- Cs <br /> istance to nearest of lin <br /> No. of compartments---------- ------Liquid �Iepth <br /> Dispos�VFielcl: Distance from nearest well: from founclafion1e ................ <br /> Length of each line-71 <br /> 4.71 Width of french----- -- ------------------------ <br /> Number of lines------------ ---- -------Length----------- <br /> or --------------------------- <br /> Type T filter rr of filter Total length <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._.-----__--.---_ <br /> ❑ <br /> ine--.-------------- <br /> n Number of pits----------------------Lining material-----------------------Size: Diameter----.--.---------------Depth-------------- ---I-------------- <br /> Cesspool: Distance from nearest well-------------- --Distance from foundation------------- ------Lining material____-._----.------___------_----._.- "Ilk <br /> 0 Size: Diameter- ----------------- ----------------Depth-----------------------•----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> 0 Distance to nearest lot line--------------------------------------- ------------------- ---------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------- --------------------------------- ----------------------------------------------- ------------------------------------------------------- <br /> -------------------­ ---------------- -----------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------I---------------------­-11----------------­-----•------- ---- I----------I------------------------------------------- <br /> -- --------------------- ----------------I------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- <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 /> (Signed)--------------------------------------------- ------------- ---------------------(Owner and/or Contractor) <br /> ... -------------------------------------------------------- <br /> --------- ----- - ---------- ------"_ <br /> ----------- - -------------------------------------- - ------(Title)------- <br /> By:---------------------------------------------- -- ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY_5jj _�------------- -- ----------------------- ------------------------------------------- DATE ------------------------------------ <br /> REVIEWEDBY--------------------------------- - - ---- -- ----I ---------�-.:---- -- ---------- -------------I------------ ---------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------ZI--m---------------------- --------------- --------- DATE--...... ------------------------ --------------------- <br /> Alterations and/or recommendations:- -------------------------- -----------------------------------------------------------•---------•------------•------------------•------- <br /> t.- ----- <br /> -----------------------------------------*1------- <br /> ------------------------------------------------------------__-------------------------- <br /> --------------------------------------------------1-------------- --c I-------- <br /> ---------- /71 <br /> I ------------- <br /> ------------ ...... ------- ----- ----- ------------------ ------------------------------------------------- ------------------------------------------------- <br /> -------------------------------I--------- + j" W-------1_------------------- <br /> ---------------------- ---------- -- --------* -----------------------*--------------- ------------------------ <br /> --------------------- ----------------- -------------- <br /> --------------------------------------------------------------------------------- <br /> ---------------------------------------------- -------- ---- ------------------------------------------------------ <br /> Date <br /> FINAL INSPECTION BY:-.--.. --------- .........6)_&� <br /> �7------------------ ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> ES-9-21A 145446 ATWOOD 12-54 <br />