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APPLICATION FO,ANITATION PERMIT Permit No. ..... ........... <br /> (Complete in Duplicate) Date Issued <br /> Applica4-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. 5493,0 ""To"The work here-n cl, <br /> JOB ADDRESS AND LOCAT40 -- - - ---------------- ----- ------ <br /> ---- ------ ----- - - - -------- <br /> Owner's Name_ --- -------------------- --------------------- ---------------------- Pho -- - ----- <br /> Address ----------------/_� --- ---------- <br /> -------------------------------•----------- - ------------ ........ <br /> Contractor's Name---------• ............ --------------------------------/---------------------- - --- ------------ Phone <br /> Installation will serve: Residence X Apartment House E] Commercial ❑ Trailer Court 0 Motel E] Other ❑ <br /> Number of living units: Number of bedrooms ___/._ Number of baths ---/--- Lot size ---- _______________ <br /> Water Supply: Public Community system E] Private Depth to Water Table�a ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay El Adobes' Hardpan 0 <br /> Previous Application Made: Yes [-] No New Construction: Ye� No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___��9__ Distance from foundafion__./d.�---------Matp -- <br /> ---- <br /> No, of compartments-- ---------------Size-- <br /> . ";ial <br /> I .........Liquid depjk___;V_z-------- -----Capacity.,------ <br /> Q .- <br /> Disposal Field- Distance from nearest well.167e, ......Distance from foundation___/67.!�__.Distance to nearest lot <br /> Number of lines_______1_.________-_._.----4-------Length of each line-------- -9 /_._____._.Width of french--------R.4-7 --- ------------- <br /> Type os filter material _ _�--------Depth of filter material_---- .__.___Total length____.-__._ ------------------ <br /> Seepage Pit: Distance to nearest well_/,v�---------Distance from f03ndaflon___,/e---------Distance to nearest lot line________________ <br /> x <br /> ine---- ---------- <br /> xNumber of pits___._.I----- ------Lining materia ------Size: Diameter._._._W..........Depth--------12-0 11------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------- -------- Lining material--------- ---------------------------- <br /> 171 Size: Diameter----------------- ------------------_Depth------ -------------------------- ------------------Liquid Capacity-----------------• ---------gals. <br /> Privy: Distance from nearest well---------------------------- ---------------------Distance from nearest building-________.__-____________----____________- \� <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot line-------- -------------------------------------------------------------- -------- --------------------- -----------­-------I------------ <br /> Remodeling and/or repairing (des 'fie):____ ---- .......I------- .... . ... -------- ----------- <br /> ?------------------_------ ----------------------------------------------- ------------------------------ ----------------------------- -------•---------------•----------- --- <br /> � ��T t✓% �` -•----- <br /> ------__1----------------------------------- -- ------------------------------------------------------- ------------------------------- --------------------- ------------------------------ <br /> ----------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------1­-------------------------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, )SJc\fe law <br /> ,�2and rules an ulafions of the San Joaquin Local Health District. <br /> -------- -- ----- Contractor) <br /> ----------------------- ---------------------------------------------------- Own or <br /> (Signed).... ... -- - ------------ Contractor) <br /> ... . .. ....... ..... (Tif I <br /> By:............... --------------------------------------------------I----------------------------- -------------I - ------ ------ ----------- <br /> 4 rs <br /> �� r(Ow <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p ceid on re rse <br /> FOR DEPARTMENT USE ONLY <br /> -----------3- <br /> APPLICATION ACCEPTED - - - ------------------------------------------- DATE_f7-4�— _74_7_ --------------- <br /> REVIEWEDBY-------------------------------- ------------ -------------------- ------ - ---------- -------------------------------------- DATE------ ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------- ---------------------------------------- ---------- DATE-----,---------------------------------------------_------ <br /> Alterations and/or recommendations:----------------------------------------------- ------------------- ---------------------------------- -------------------------------------------------------- <br /> ------------------------- ---------------------------------------------------------- ---• ------- ----------------------------------------------------------------------­----------------------------------------- <br /> ---------------- ---------------------------------------------------- ---------- ------------------------------------------------------------------------_------I­-----------------•---•----------------------------------- <br /> ------------------------------------------------------------------------- <br /> -------------------------------------------­ <br /> -------------------------------------------------------------------------_­------------ -- ------ ------­------------------------------------------------------------------------------ ------------------- ------------ <br /> - -------------------------------- ------------------------------- -------------------------•--------•----------------•--.--_----------------- <br /> FINAL <br /> ----*--------------------------*-------------------- <br /> FINAL INSPECTION BY:.- <br /> 4 ,Z1,11 ----------------------------- ----- ^-- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufk American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lod;, California Manteca, California Tracy, California <br /> ES-9 145446 ATWOOD <br />