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y <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._ _ 3.!-- , <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. <br /> u_o w . rcas��> � �D' t '- 3�7 ._ro2���I <br /> JOB ADDRESS AND L CATION---� -- �J ! --=------------------------------- <br /> ------------------------- ---------------------------------------- <br /> Owner's Name _CF----- ---------- ------------- ---- ----- ---------- Phone------------- --------------- <br /> Address <br /> ------------- ` <br /> Address-----------��------- -- -- ------ - ._ <br /> ----- . <br /> Contractor's Name----------- --- -•---------------------------------------------- -------------- ------ Phone.------------------- ----...{- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ f <br /> Number of living units: .1----- Number of bedrooms ___�__ Number of baths __j____ Lot size <br /> Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand W Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan r. <br /> Previous Application Made: Yes ❑ No jo New Construction: Yes x No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,Z <br /> (No septic tank or cesspool permitted if public sewer is available within 200 eet.) <br /> Septic Tank: Distance'from nearest well --------------Distance from foundation-------------------Material---_-----..__.__----------__-_-----.__.__------. <br /> ❑ No, of compartments!-. ------Size------------------- ------------Liquid depth-----------------------_Capacity----------------------- <br /> Disposal Field: Distance from nearest well----------------Distance from foundation----------..........Distance to nearest lot line----------------- <br /> Number <br /> ._--_-------- <br /> Number oi.lines---4---------------------;-.--------Length of each line----------------------....-_-'Width of french.--------------------- --- + <br /> Type of filter material-l------------- -- ----Depth of filter material----------------------- otal length----------------.------------------------- <br /> ir ' p <br /> p e Pit: Distance to nearest el!_.__ - --1- -lDistangKorn f ndation____�_ __.___. ist nc to nearest lot I`ne_.. hSee Number of pits....__ __________Linimateria ize: Diameter_______ _ ____ _ Depth- � - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material--.-.-------------------ff- <br /> Ej <br /> Size: Diameter------ -- -------------- --------Depth-------------------------- - -----------------------Liquid Capacity---------------------- <br /> Privy: <br /> --------------------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------............... <br /> ❑ Distance to nearest lot Iine------------------------------------------------------- --------------- -------------------------------------------- - <br /> t <br /> Remodeling and/or repairing (describe): --le A:p* / - ---•- -- ------------- ------•-------- <br /> ----------------------•----_-------•----------• -----•------------------------------------------------------- <br /> ------------ ----------------------------••--------•------------------------ ------------ <br /> ---------------------------------------------•-------------------.-----••--------------------•---------------------------....-----•----------------------•---• ----•---•------------------------------------------------ <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 /> /) <br /> (Signed) .,,(/s,�t - _..-(Owner and/or Contractor) <br /> By:----------------------------------------------". -•--------------------------------------------------.._...-----------------------(Title)------------------ ------------------------- - ------- --------- <br /> (Plot plan, showing size of lot, location"of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------------------------- •----------------------- ------ DATE- <br /> REVIEWED BY------------------------- ------------------- ---- ------------- --- -- -- ----- ` - DATE----- c <br /> BUILDING PERMIT ISSUED------------- -------------------- -------------- -- --- -- -- ����r ------ DATE-.--------- - <br /> Alterations and/or recommendations------------ --------- - --- ------------------------•-----------------------------•----•-----------•-----... ,. . <br /> ---•---------•---•----------------• ------------ -------------- ------ <br /> -----•-•-----------------------------•------------------------------------------------------ -------- -----------------------------------------------------------•-----. ------------------------------------------------- <br /> ----------- ------------------- ---------------------- --------------------- ----------------------- -----------------­........... ---------- --- - --------------------------------- ------------------ ----------- <br /> ------------------------------------------------------- -- -- -- ----I ---- ------- ---------------------------------­-------------------------------- ------------------- ------- 11----------------- <br /> FINAL <br /> --------------------- ------------------------- <br /> FINAL INSPECTION BY:------------ ---- �/ � <br /> - •-•----. Date - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American $free+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--$ 145446 ATWOOD <br />