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APPLICATION FOR SANITATION PERMIT Permit No, <br /> (Complete in Duplicate) s <br /> Date Issued <br /> Applica*ion 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 Ordinance No. 549. •I- <br /> JOB ADDRESS AND _f 1 <br /> ATION___�-'! '_ _ na4' <br /> .-__. 1 - '?- N� _-__+ r.___I J r.._. __ = _ <br /> ----------- <br /> Owner's Na a 4' x`- --------------------------------------------- Phone.---------------- ------------•- <br /> ,,y <br /> Address----- �7__._ al �• :.. �.... <br /> Contractor's Name...................... -Q. ------------------------------------------------------------------------- Phone-A--Z--g-kP <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms _V Number of baths ._f_.._ Lot size _ -17 ----••------------- <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Tabl;��E] <br /> ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [—] Clay Loam Adobe R--`H`ardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tank: Distance from nearest wwnell_ 00!0-----Distance from foundation---/.A2_ ------.Material__._. � <br /> [ � No. of compartments...QCs------------.______Size f'_ _. ",___Liquid depth_-15T M_.._�__�_.__Capacif�y.-_7i_ <br /> DispoosaField: Distance from nearest well./_Q'�--'---Distance from foundation---/_'&t --------Distance to nearest lot line..... <br /> Number of lines-------Y-------_- __ Length of each line__-�"--------------Width of trench..____ __?�_'..__...________ <br /> Type of filter material._/.Ir__ _____Depth of filter material------/Af_"--------Total length_-_.4_0.._'_......................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line____---__________ <br /> ❑ Number of pits---.............. ....Lining material----------------------- Diameter-----------------------Depth.................................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------.----------Lining material--------- ---------------------_•.-__. <br /> ❑ Size: Diameter--- ----- ----- -----._.Depth----- ----- •-------- -------- -- --------Liquid Capacity,__.,,,._._.,,.._...•— <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building----------------;____-______-_.-_.-__-___. <br /> ❑ Distance to nearest lot line------------•-----------••----------------•------••---•-•---•--------------------------•--------------•--_____---------••------ •-------- <br /> Remod ling and or re airin (�d+e�cribe):_---- ,eta► 6_ _ __._ ................�._�y1`�.._-+t'_. �!��------ - ---- - ---g -y--1l--.Q-- - --- ------ •. <br /> ----------------------------------- ----------------------------------------------------•----------------------•--------------------------•-------------------------------------------------------------------------------- <br /> I her y cerci y at ( have prepahis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, , and rules and�rVeafflons of the Sa Joaquin Local Health District. d <br /> V <br /> (Signed)------------------ -------------------------------------------------- -----. ----- ------------------------------------------------- or Contractor) <br /> By:......................................................... ------ -----• --- ---- -- =---- ---- ----___(Title)--------------- ------------------------ --------------- <br /> (Plot plan, showing size of lot, location of system in re tin fo wells, building etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 4. <br /> APPLICATION ACCEPTED BY- -------------------------------- ------------------------------------------------•----------- DATE. ---- -------------- ---------------------­- <br /> REVIEWED <br /> -----•--------- --REVIEWED BY--------------------------------- --- - ----------------------------------------------------------------------------------- DATE---'e.................................................... <br /> BUILDINGPERMIT ISSUED............ -------------------•--•------------------•------------------------------------------- DATE------ -•------••----••.......•--•••••------- <br /> Alterations and/or recommendations-------- -------------- ------------------ ----------------------------------------------------•-------- <br /> ------------------------------------ -----------------------------------------................................. <br /> ----------------------- <br /> •--------------------------------------- <br /> ----- •------------ ------------- ----------------_ <br /> FINAL INSPECTION BY: ------------------ --------- 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 /> E5---9-2M 145446 ATWOOD 12.54 <br />