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APPLICATION FOR SANITATION PERMIT Permit No. _ <br /> ___-..�/_�... <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. <br /> JOB ADDRESS /�D LOCATION.-JO-0-7 5 - -'-`-J--------•----------- --------------------- <br /> Owner's Name --------a� rr-f ------ - Phone <br /> Address `3--,�0` " <br /> Contractors Name (Y- - - 3-1---I---`----------ly-1 --------•------------------------------------------- Phone 70' -��- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E9- <br /> Number of living units:,___-.--- Number of bedrooms ------- Number of baths ----------Lot size` --__�t.__'r.---"-------------_-_--_.-__-_--_ <br /> Water Supply: Public system,❑ ' Community system ❑ Private Depth to Water Table - --_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gra'vel ❑ Sandy Loam ❑ yClay Loam❑ Clay ❑ Adobe 0---/Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes '.{No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t .� <br /> (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) / ` r <br /> Septic-Tank: Distance from:nearest well .0------Distance from f undation-1-..-_-.____Materia#_____ __________,_____ <br /> �r <br /> No. of compartments--- ze_r:�� f-14 <br /> __ _ .....Liquid depth_...s1 ,_.__-.-_._Capacity_. <br /> Disposal Field: Distance from nearest well__-._.-_Distance from foundation ..Distance to nearest lot <br /> r-- <br /> [ Number of lines-------_�-..:.........�f. Length of each line_-/�S_-----._.----__ Width of trench_,X_�_`/.__----_-_--.-._. <br /> of filter material.� : �d-N...Depth of filter material..__le_�_'--__._-_Total length--_�_®-9..'---------------------- <br /> Type <br /> Seepage Pit: Distance to nearest well__ _'"`-_____Distant r rom ffoundation_-1�'f'-----_sft nce to nearest loft line._._..--- <br /> ]/ [ Number of pits ' Y Lining material Y•I Size: Diameter 6� r Depth.`. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------------------------- <br /> 0 Size: Diameter--------------------------------------.Depth--------------------------------.--------- ----------Liquid Capacity----------------------------gals. 0 <br /> Privy: Distance from nearest well ______________----------------------------------Distance from nearest building-------------.______---___-_-._-.-__-__.. <br /> ❑ Distance to nearest lot lire----------------------------- -----------------•----------------/----{=•-----f-------------•------------------------ ----- -------- V <br /> Remodeling an /or epairing escribe�j:----- ✓_.------0� .r c-------------------e-- -----�'----�-__-�a____------�---- , <br /> -------------• -------- ---•-------- " ' " -------------------------------------------------------------------•----•-•----•------------•-------•----------•--....-----'--------------------- <br /> --------- <br /> ------------------------- ------ --------I-•----------------------------------------------•----•--------------------------------------------•---------------------------------------------------------- <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 rules and regulations of the San Joaquin Local Health District. <br /> f_____ 1 Owner and/or Contractor , <br /> [Signed)•--------------------- ----------------------------------------------------n------------- --------------- /0-------------- _ ( / I <br /> By:--•---------------------•--_-_------------------ -------------------------------------------- (Title) ��� .'---------------------------------- <br /> (Piot plan, showing size of lot, location of system in relation to well,�guildings, etc., can be placed''on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------------------ -- ---- ------ ------ ------------I-----­-------­---------.DATE -------------------------------------- <br /> REVIEWEDBY--------------------------------------------- ------------ --- --------- ---------------------------------------- - DATE------ -------- <br /> BUILDING PERMIT ISSUED------------------------------------- -- -- - DATE---------- -- <br /> -- ••-----------•-------- <br /> Alterations and/or recommendations:-------------- ----- ---------------------------------•-•---------------------•-•----...- �-t------------------------- <br /> �` ---------------- `..= ' <br /> - <br /> ---------------------------- ---V-------•--- -`----------------- -•----- ---------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------__--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> _�— ) -7 - _�I <br /> FINAL <br /> -;------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:____�I_s-_--.----_ - � ------------ Date------....��-_--�.-_�_�� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 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 ATWOUD 12-54 <br />