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�� <br /> 4 APPLICATION FOR SANITATION PERMIT Pornnif No. <br /> (Complete in Duplicate) 5 <br /> rT Date Issued -------- <br /> A <br /> �plical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> " <br /> L CATJON <br /> JOB ADDRESS AND 0 .. -V 0 e- <br /> 12L - - -_2 --- ---------------------------------- <br /> Owner's Name--- ---------------------------------------------------- -r................................... ........ Phone.__3 e� 3 <br /> Add ress <br /> honeA---- <br /> Address---------------------------------- <br /> Contractor's Name----- ..aV_1 - ------ ----------------------------------------------------------- Phonelk--- ------- <br /> Installation will serve: Residence ff--"Apartment House L] Commercial L] Trailer Court E] Motel Ej Other ❑ <br /> Number of living unifs:-.,_t_._._ .ml�e`r of bedrooms __P�Iumber of baths ---/ Lot size <br /> Water Supply: Public system �.- �Communify system E] Private 0 Depth to Water Table <br /> ,,4o ft. <br /> Character of soil to a depth of 3 feet: 'Sand E] Gravel El Sandy Loam L] Cla Loam 0 Cl E] Adobe F-'0HardpanC] <br /> Previous Application Made: Yes Ej No [p"'New Construction. Yes [] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> wic,T Distance from nearest well-__ ----------Distance from foundation--------------------Material---------------------------- <br /> ---­---------------- <br /> No.--of compartmerils-------------------------.Size-----------�­-------------------Liquid depth---------- ---------------Capacity----------------------- <br /> i <br /> epth---------- ---------------Capacity----------------------- <br /> I -Sal vald. Distance from nearest well-________________Distance from foundation-------------.-_-.Distance to nearest lot line________-________ <br /> Number <br /> ine----------------- <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter rriateriaJ----- - --------------Depth of filter material---------- ------------Total length------------------------------------------ <br /> I <br /> Seepage Distance to neai 4 D o­m- on tion-1.2-.0e---.Distance to nearest 19t line-----41. <br /> V� Number of pits___ a ---- 01.e -/ <br /> m . . .. ze 3 ----- ---Depfh__,Z._S-------------------- <br /> Diameter.-, <br /> fa <br /> Cesspool: Distance from nearest well_________________Distance—from f 6,ndation................... Lining material__-___....____._--_-___.._._-__-____ <br /> ❑ Size: <br /> aterial-- --------------------------- <br /> Size: Diameter-- - --------------- Depth------------------------------ ---------------------Liquid Capacity_-------------------------gal_ <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.________.______-_______..__.-_____ . <br /> ❑ Distance <br /> uilding----------------------------------------- <br /> Distance to nearest lot line------------------------------------------------------------------- <br /> Remodelingor rep i ing (describe):--------- -------------------------- ---------------------------------------------------I-----------------------------*--------------------------- <br /> --------------------- ---------------------- -1--------------------------------------------------------------------I--------- ------------------------------------------:------------------------------------------------ <br /> --------------------- ---------------------------- - ------------------------------------------------------------------------------------I----------------------_--------------------------------------------------- <br /> ----------- ----------- ----------- -------- ­I ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------1here cer have r4ared this pplication and that the worl(.will be done in accordance with San Joaquin County <br /> : . I <br /> ordinances, ate laws, and rules and regulafio s f the San Joaquin 'Lo Health District. <br /> (Signed)--------- ---- <br /> --d-P.m -- <br /> [Signed--------- JII- ----- - ---------- ----- - - ------------------------------------------------ 7ed Xoaracfor) <br /> -- -------- --- -- ----- --------------------------------------(Tit <br /> By:------------------------------------------i:..... ... --- --------- <br /> o syste i <br /> (Plot plan, showing size of lot, loca-i n elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> n <br /> in <br /> g <br /> -------------------------- <br /> c------ - --------- <br /> e r reF <br /> f <br /> r c <br /> e laws and r an <br /> APPLICATION ACCEPTED BY...... ----- ­ ---- <br /> ---------------------------------- --- ----------------- DATE <br /> ------------ <br /> REVIEWED BY--------- <br /> ------------------------- - ----------- ­---------------- ------------------------------------- DATE_- <br /> ,Z> <br /> - ' -, <br /> - -- - - <br /> --- <br /> BUILDING PERMIT ISSUED--- Z ----- ----- --- DATE..--------- - ---------- ----------------- <br /> Alterations and/or recommendations:-------------- <br /> ------------------=------------ ------------------------------------------------------- ----------_6 --- ------- <br /> -------------------------------------------- ---- -----­­---------------------------------------------------------------- ------------------------­ -------- <br /> ------------------- <br /> - <br /> --------------------------------------------------------------_-----------•-••i __..... .................. ------------------------------ ------------------------------------------------------------ <br /> ------------------------------------------ -I----------------------------------------------------------------- ---------------------- ---------------------------------------------------- -------------- ................. <br /> ---­.....I------------------------------------------ I---------- -------------------------------------- -­------------------ ...._1------------------------------------ ------------------------------- <br /> FINAL INSPECTION BY: Date----�;_ --� '-�- <br /> ---------------------------------------- ------ ------------------------------------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Souf6 American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California I Lodi, California Manteca, California Tracy, California <br /> 145456 ATWOOD 12-54 <br />