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P_ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ---- 5 <br /> grA -ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> plica4 y Ordin No. 549. A-t- <br /> is application is made in compliance with Count 0 din ce <br /> 1?5 to/ A <br /> -IrOCA - 2- &---, / <br /> JOB ADDRESS N T 10 N --------------------Alnlu4 <br /> --- -------- ------------------ <br /> Owner's Name_....... ----------tC -- ------------------ <br /> & .'sjW-A — C,- ------------------------- <br /> Address------------ .Afn-----------------f.......... ------------------------------------ --------------------------------- <br /> Contractor's Name----------------0!�10,1k------�_ -1---------------------------------------------------- Phone--_4 90_d_;Z_ <br /> Installation will serve: Residence [Apartment House ❑ Commercial E] Trailer Court [3 Motel El Other El <br /> Number of living units: _1--- Number of bedrooms A--,-Number of baths ---/--- Lot size --- ---r---_ <br /> Water <br /> ------- <br /> Water Supply: Public system El Community system Gpo'frivafe ❑ Depth to Wafer Table I <br /> /Aff. <br /> Character of soil to a depth of 3 feet- Sand E] Gravel [] Sandy Loam E] Clay Loam 2--bay [:] Adobe[R--<ardpan [I, <br /> Previous Application Made: Yes 0 NoQ��e, Construction: Yes U;--No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ,7 <br /> 'n-/ - <br /> Septic Tank: Distance from nearest well_14t_1V_____Distance from foundation- . Material-----C, <br /> No. of compartments-.___Z -------_____Size- n!!434" A,---Liquid depth--- I. .............Capacity---9'--0-9-------- <br /> Distance from nearest well__----- frorr_i�o`=n 1-1 <br /> Disposal Field: ------- (7 '3 r ound fion_,)�-_O------,.Distance to nearest lot <br /> Number of lines-__---A----------------------Length of each Iine___..&W' AIW-----Width of trench ----------- <br /> Type of filter material-----/._�V"_Rk__Depfh of filter material----./P __-.3otal length-----41m--____------------------ <br /> ------ <br /> A5- <br /> Seepage it: Distance to nearest we1I_C_tY4_-_--'.___Distanc from foundation,._<_Q."._.Distance to nearest lot line---- --------- <br /> �9� <br /> Number of pifs� J�Zj�------- Size: Diameter----Z_3 0�__Depth__..,#*V)-4-1 <br /> N _J -------------Lining material- --- ----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation --- ----- - Lining material_-._-__--.-._-_-----_-----_------_-. <br /> ❑ <br /> aterial-------------------------------------- <br /> 0 Size: Diameter------ ------------------_----------Depth-----------------------------------------------------Liquid Capacity- --------------------------gals. 7 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 00- <br /> ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------- ------------- ------------ ----------------------------------------------------- ---------------------------------------------------------- <br /> ­...................I—-------------------------------------------------------------------------------------------------------------------------------------------------------- ..-----....._..-••------- <br /> ---------------- <br /> •-------------•----------------------------------------•----------------------------------------•---- <br /> ...............I------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> averea, I <br /> ----------------------- - ----------•---------•--1------------------------•---------.. .---•------------------------------------------------------------------------------------------------------------- <br /> I hereby c rfify at I have prepared fk* pplica and that the work will be,done in accordance with San Joaquin County -1 <br /> ordinances, St I and rules d egula io s of the an o quip L?cal Heallf",,bisfricf. <br /> ...... ntractor) <br /> (Signed)--------------------- -- -- - - -- ------- -- -------------------------- --- ---------------- --- - - ----- --------- -Co <br /> By:----------------------------------------------------------------------------- .. (Titl -------------- <br /> -------- -- ---- -------------------- ------ ----- <br /> ld t <br /> -on <br /> (Plot plan, showing size of lot, location of system in relat on o wells, buildings, e can be pla ed on verse sidre� <br /> FOR DEPARTMENT USE ONLY <br /> -- ------------------------------------------- <br /> APPLICATION ACCEPTED BY--------------- ----------- ----------------------------------------------- DATE--------- <br /> REVIEWEDBY------------------------------------------------ --------------------------------------- ----- DATE------------------------•-------------- ---------------- <br /> BUILDING PERMIT ISSUED---------------------------- ----------------------------------------- ------------------ DATE------------ <br /> ------------ ------------------- <br /> Alterations and/or recommendations:------------------- ----------------­- ........ ...... ............... -----------I——......�---------- -—------------------------ <br /> ------------------------------------- -------- --------- ................. <br /> ------------------------ ----- ---- ­-----------­------­ ---------------------------------- <br /> ------------------------Z1111---------------------- ----------- I--- <br /> ----------------- A- k------------------------------- -------------------- <br /> ------------------------------------------------- -------------------------------I-------------------- -- --------------------------------------------------------------------------------------------------- --------------- <br /> -------------- ------------------- ---------- ---------- -------------- ------ - ...... ---------- ---------------------------------------------------------------------------------- <br /> - - ------------ Date--------/-5-- ---4-------_---4----4---- <br /> --------------------- --------------------- <br /> FINAL INSPECTION BY:...... ---------------- <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 /> ES-9-2M 145446 ATWOOD 12-54 <br />