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- r r <br /> I � � APPLICATION FOR SANITATION PERMIT Permit No. <br /> �j (Complete in Duplicate) -� <br /> Date Issued ---__zw�____._. <br /> Aps alication is made in comfiance with.Countplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> pp p y rdinance No. 549. <br /> Thi <br /> JOB ADDRESS AND LO ATION____ <br /> ----.----•---•--------------•---••-----••--------------•---------------- <br /> Owner's Name-- "`' - --- --- --- ---------------- -- --- - --- ------------------------ <br /> Address-----------f <br /> ---------------Address-----------L ..VL A. _....��•---------------------------•---------------------•------------------•-•-•--------------------.-.------------------•-------- <br /> Contractor's Name-----------------------•---- --------•----------••----------------------- --------------------------------------------------•---------- Phone----------------------------------- <br /> Installation will serve: Residence &f/Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofe�l ❑ Other ❑ <br /> Number of living units: ___ ___ umber of bedrooms _ . Number of baths ._!____ Lot size _i_Q5J_0_ _f 1(.�_________________________ r <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ______ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy LoVNo <br /> Clay Loam E] Clay F] Adobe Hardpan ❑ <br /> Previous Application Made: Yes E] No 5 New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic a[il��Distance from nearest welf-----------------Distance from foundation--------------------Material---------------------------------_-------------_. <br /> ❑ � Wl o. of compartments-owell <br /> --------- Size---------------------------------Liquiid depth- i----------------Capacity-----------------I--- <br /> Dispos ,field: istance from nearest Distance from founds in_d._f ________ istance to nearest lot lie__C ' <br /> Number of lines_______._ _' �Length of each lin ____�_~a�___�_�__ �Width of trench_______ ___e__________Type or' filter materilDepfh of filter material-- Total length'__________ _______________ <br /> Seepage Pit: Distance to nearest well-----______------------Distance fromTfoundationa'__'�_ --------- Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material----------.-----:--.---Size:i.Diigameter------------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___4_.--------------Lining material_--------------------- ---- <br /> Size: Diameter _: _ Depth r- = = =:-_ _ ---_ Liquid•Capscity-- �---------•------gals. <br /> �,. .— f <br /> Privy: Distance from nearest well---------------------------------___-------------Distance from nearest building___________________________________.._._. <br /> ❑ Distance to nearest lot line------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------- ------------------- -------------------------:----------------------------------------- --------------------------------------------.------------- <br /> -------------------------------------------------------------------------------------•---------------------------------------•----------------------------------------------------------••------------------------------ <br /> ­ <br /> ------------------------------------------------- ------------------------•----•--------------- -------•----------•------•----•-- ----------------------- - ------------------------------------------------------------ <br /> I herebycertify 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. z <br /> 1 -..s.•• � 4 � f <br /> 1 <br /> � 4 I; <br /> 51.G---___ __ -_ --.Owner and/or Contractor <br /> (Signed--- --•- --• -------- - - -"'-`-`�-{-`� = - - ------------------ ----------------------------------`------------------------- �- ( / 1 <br /> By: (Title) --- ------- <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- ------------------------------------- ------------------------------------------- DATE ------------------------------------------------------ <br /> REVIEWEDBY------------------------------- -- ' DATE- �------------------------------------------ <br /> DATE.. ... __-- <br /> BUILDING PERMIT -IISSUED--------- f - �� <br /> Alterations and/or recommendations:__..---__.__.-_ � <br /> , � i <br /> -•-•------------------' ...---------------------------------•--------- = - <br /> ----- ------ ----- ------ --------------------------------•---------------------------------------------------------------------------------------- <br /> ' a_ f <br /> =r <br /> -------------------------------------.----------------------------------_.------ -----------------------------------------I----------------------------------------------------- <br /> ' Ll' <br /> f V� <br /> FINAL INSPECTION BY:. ---- - ---------------------------------------- t Date . <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 /> ES--9-2M 145446 ATWOOD 12-5. <br />