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APPLICATION FOR SANITATION PERMIT ,�,i4 ")Permit No. .. ................. <br /> (Complete in Duplicate) Date Issued <br /> Aplica+ion is hereby made to the San Joaquin Local Health Disfricf,for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinanc No. 549. <br /> JOB'ADDRESS VCA I <br /> ---- ---- <br /> N------- <br /> e------------ ---- -------------- -------------------- <br /> l-!--- ---Owner's Name -------------------------------- ------------------------- <br /> Phone <br /> Adclress------ ---- -- <br /> --------------- -------------- --------- <br /> lConfractor's Name--------- --- ----------- ---------------------------------------------------------- <br /> - ---------- - ----- -------- - <br /> ----------------------------------- ------ Phone <br /> & <br /> Installation ----------- <br /> will serve: eside nce Apartment House ❑ Commercial [] Trailer Court E] MotelE] Other ❑[] <br /> Number of living units.-::-/---- Number Of bedrooms j-- Number of baths .-/-. Lot size • <br /> Water Supply: Public sysfemx Community system El Private E] Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand D Gravel [] Sandy Loam [-] Clay Loam L] Clay E] Adobe ]' Hardpan <br /> ❑ <br /> Previous Application Made: Yes Lj No 9 New Construction: Yes x No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ----- Distance from foundation--j0-/....Material 0/c, &4, 1— <br /> Septic Tank: Distance from nearest we11 - ------------- <br /> No, of co4arfrnents.. 7------------------------- <br /> - <br /> --------S�ze��"I-Xq-&"--Liquid depth--- <br /> - -------Capacity-lr__�. i- <br /> Disposal Fie�cl: Distance from near�sf welle-;UIAZ -------Distance:to nearest lot line------- <br /> --------------Di,�ance from foundafion--;-?40­ - <br /> Number ol lines------j----- Length of each line-----Z� -------------- Width of trench­j�;/ <br /> Type of fil'Ifer materiale'pm- z---Depth of filter material--- --------Total length-7 ----------------------- <br /> SeVe Pit Distance +0:' nearest well-j-1V-yL.J2-."---Disfance from,�ounclation---- Distance to nearest lot line---- <br /> - / ------------- <br /> Number of pits.___.!-...__..____-Lining mate ria 1�2Q,�MeAiize: D;amefer-----��-/------Depth....1,22.e-------------------- <br /> Cesspool: Distance from nearest well---------------Distance from foundation--------------------Lining material__.__-___.__-_.____.-___.____________ <br /> ❑ Size: Diameter------------- ---------------------- Depth--------------------------- Capacity----------------------------gals. <br /> -----­------------- --Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well_____________________ __...._.__..___._._Distance from nearest building------------------------------ ---------- <br /> 0 Distance to nearest !of line_______________________.__._____---.._ ----------------------------- <br /> Remodeling and/or repairing (describe):_--_____.______._._..__------------------------------------------------------------------- <br /> --------------------------------------------------- ------------------- <br /> ---------- -----------------------------------------------------------------------------------------------1---------------------I------------­--------------------------------------------------------------------------- <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 /> ordinances, State-laws- and rulps-and regulations of the San Joaquin LLO I H Ith District. <br /> County <br /> - --- ----- --------------?------- (0 nar and/or(Signed).---_ ... .. .................Nj <br /> - --- --- ------------------------- - <br /> ----------- ----(04n2&r and/or Contractor) <br /> By: ------ <br /> .... . ... <br /> ----------(Title)-. - -- --------- <br /> (Plot plan, showingLfs4ze of lot. I.oc`a-ii-o-n of sys in relation to wells, buildings, etc., can be placed on reverse--side). <br /> - -------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> i- I ------------------- - -------------------------- ------------------------------------------- DATE-------------------------- <br /> REVIEWEDBY-------------------- :,--%k-- rs- ---- ------------------­­ --------------------- --------------------------------- DATE-'-' <br /> -------------------------------------------- ----------------- D ---------------------------------------------------- <br /> BUILDING PERMIT ISSUED. --------------------------------------- <br /> Alterations and/or recommendations________________________________----------------------- <br /> j. --------------*1------- <br /> ----------------------------­-------------- ---------- ------- ------------------------- ------------ -------------------------------------------------------------------------------------------- --------­­--------------------- -------------•------...-_ --------------------------- ---------------------------------------------------- <br /> ------------------------------------------------------ ------------I---------------- ---------------- --------1-------------------­----------------------------------------------------------------------------- <br /> ---------------I------------------- ------------------------------------------­­-------------------------------------------­ --------------------------- ---------------------------------------------------------------- <br /> FINAL INSPECTION BY:- s--------------------------------------- Date-----U------------------------------- <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 1 Z-Sa <br />