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zti­ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <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 ANtil <br /> OCATION..:.i0-f�a- --- �-A.. L-0-v------�n�E'[e ....... <br /> r <br /> Owner's Name--------- ft-L --------------- -------------------- -- <br /> ( J --------- <br /> Contractor's <br /> Phone--------=--------•-•---�-7--- <br /> .. <br /> �MG--------------------------------•-•--------------------- ------------------------••-----------------•--•--------. <br /> --- <br /> Address ------- --- <br /> Contractor s Name------------ ------- -I"_'.�--15.�----------- -ham-- ----------------- - <br /> ------------------ -----. Phone..... ------ <br /> ---- --S� <br /> Installation will serve: Residence Apartment House E] Commercial F] Trailer Court C] Motel E] Other El <br /> '/ '� 1.. v------- -----•-- <br /> Number of living units: ----- Number of bedrooms '/ Number__-_- Number of baths ---I__ Lot size .-.-_ _-_- . <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabl __ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑. <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ = 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S �Ta6 ;stance from nearest well-----------------Distance from foundation._.--__--_-_.--_._.Material_.----._.-_-..---.---..__-___•--_--..----_------ <br /> o. of compartments_._---------- ------------Size--•-----------------------------Liquid depth.-------------------- ---:Capacity----------- ------ <br /> i sa Distance from nearest well_______________ Distance from foundation----------------.._.Distance to nearest loft line----------------- <br /> Number of lines---------------------- Length of each line-----------------------:-----.Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length--------.----------------------------•---- <br /> ,� . <br /> Seepage P Distance to neares well-_'____ _____________Distanc fe r `foVndation__6_f�_..___.__.Distance to nearest lot lin�..1�_.____ <br /> Number of pits..--_----------- Linin material �}---Size: .Diameter__ -"..____Depth... ___________________ s <br /> [ROOLining -- JJJ p <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__----.--.--_-.___.Lining material--..-..------------._-_-.__.-________. �1 <br /> •❑ Size: Diameter----=---------------------- ----------Depth--------------------- ----------- ----------------Liquid Capacity----------------•------- gals. <br /> Privy: Distance from nearost well--------------------------------------------- ---Distance from nearest building----------------------•------------------- <br /> ❑ Distance to nearest lot line-------- ----------------- --------- --------- ----------------------- --------------------------------------------------------------------- <br /> I . -------------------------------- <br /> Remodeling and/or repair;ng (describe):-- ------------ - ---------- ----------------------------•------•------------- <br /> ------------•-•----•---------•-------------------- <br /> i <br /> ----------------------- <br /> ce ' that] have-prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan e, State lav-?), and ule ra ons of the Joa uin LacHealth District. <br /> (Signed) ) C --- --- ------- --- - ------- ---------- d Contractor) <br /> r <br /> E - --•--- ----(Titl ► /i�?_U� r ------------- <br /> By------------------------------------------------- ----------------- --------- - e <br /> (Plot plan, showing size of lot, location of system in r a on to wells, buildin etc., can be placed on reverse side). <br /> FOR EPARTMENT USE NLY <br /> 4-4 <br /> —APPLICATION ACCEPTED BY--------- ------------- -------------------------------------------------- DATE-------------- -----``---C:: --------- - <br /> REVIEWEDBY--------------------------------- --- - ---------------- --------------------------------- DATE-----------------.----------------------------------- -•---- <br /> BUILDINGPERMIT ISSUED------------------------------------ ------------------------------- ----- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:..-------•---- ------ -- ----------•-----------------•----------------------------- -----------•-------.----------------- •-------•--- <br /> , ----------------------------------------------------- <br /> --------••-----------------------------------------------------• .� <br /> ---- - <br /> ----------------------- --- <br /> ------------------ - --------------------------- ti <br /> r , <br /> BY:-------- <br /> X, Date-- ......1... ? ------------------------------- <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South America n'Street + 300 West Oak Straet 132 Sycamore Street 8i4 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12-SA <br />