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1 APPLICATION FOR `SANITATION PERMIT �, ,Ckt Permit No. ------------------------ <br /> (Complete <br /> S--------------(Complete in Duplicate) I <br /> r <br /> �, � Date Issued4. _-----l--s>- <br /> A,pplicaa-ion is hereby made`to' the'San Joaqu'sn 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 OCATION--•--- ...... <br /> � - <br /> Owner's Name----- <br /> . � tri�:------._. Phone--- -------------------------------- <br /> Address------... ------ ... -------------- •-•-----------. .................---------.---------------------------------- •----------------------- <br /> Contractor's Name..----- ---• ---------------- --- - - ----------------------------------------- Phone <br /> s� /---. <br /> Installation will serve: Residence�$ Apartment House ❑ Commercial ❑ Trailer Court E] Motel I-] OtherE]Number of living units: _/_--- Number of bedrooms 3_. Number of baths --1- Lot size ------------------ <br /> Water <br /> `--------------Water Supply: -Public system Community system ❑ Private ❑ Depth to Water Table4�971t. <br /> F <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeW Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes/9 <br /> No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publWse er is available within 200 feet.) <br /> Septic Tank: Distance from nearest welO D.Wistance from foundation--. Q- Material- C`--� ------ <br /> earesf welO -----Distance from found <br /> No. of compartments--_-_o�----------------Size-----�- D--.-------Liquid depth__--_-- -- - ----.----Capacity-- -- --- <br /> Disposal Field: Distance from nearest /well_h4 . ___ istance from foundafionjAl- _ ........Distance to nearest lot lire-----___---_--_- <br /> JF <br /> Number of lines---------1-- �/� Length of each line_---- ___-`ie-..-.Width of trench.... <br /> of filter material.�, . .d '!� .-Depth of filter material _ --------Total length--------7 ---------------------- •. <br /> Seepage Pit: Distance to nearest/well _1 -----__Dist ce from fou ..-.---Distance� to nearest lot line--- _-- <br /> 1z Number of pits.----1._-- --- 9 -------Depth- - .�- -------------------- <br /> ---.--Linin m erial�•Cr �zej iometer--..�✓__ � � <br /> CCesspool: Distance from nearest well----------------- nce from'foundatio ... <br /> esspool: material-----...._-----.-.---_.----------__-_. <br /> r ❑ Size: Diameter---------------------- ---- ----------Depth------------ - -----------------------------------Liquid Capacity----------------------------gals. <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 /> ------------------------------------------------ <br /> ----------- - ---- ------ ---- -----_---- --- - ------------ --- -- - - :--------------------------- -----•- -----------•....------------------------------------------------------------------------------- <br /> I herebycertify that 11have prepared this aI- lication and that the work will be done in accordance with San Joaquin County <br /> ordinances, laws, and ales and oa regulations of the San Joaquin Local 'Health District. y - <br /> q <br /> (Signed)... - - -..---------------------------------�t--r----- --------- <br /> By: <br /> �- r ------------------- -- ----- Owie�r'an�d'!o^r�C <br /> ontrac#or <br /> I <br /> ---- <br /> B •-------•---- --- ------------ --------------------- -(Title} <br /> (Plot plan, showing size of lot, location of syst emn.relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY�---------- DATE-M ---------------------------------------------------- <br /> REVIEWED BY----------------------------- <br /> - --IN <br /> DATE Q - <br /> BUILDINGPERMIT ISSUED------------------------------------ --=I------------------ --------------------------- -----.... DATE.------ <br /> Alterations and/or recommendations------- -------- -------------- --------------------------------------------------------------•---- <br /> ------------------•---------------------------------•------------------------------...---------------------- ---------•------------------------------ ----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> ------------------------------------- ------------------------•--------- --- ------------- --------------------------------------------- ---------------------------- ••--...-----------------.._...------------ <br /> FINAL INSPECTION BY ..�f4�--------------- ------ Date--------- 5 J - s-------- ------- ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> A30 South American S+rest 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California ` Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12-54 <br />