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j <br /> APPLICATION FOk.,.iANITATION PERMIT Permit No. ---- <br /> (Complete in Duplicate) <br /> Date Issued ---- <br /> A permit gplica-lion is hereby made to the San Joaquin Local Health District for a p "mif to construct and install the work herein described. <br /> This <br /> application is made in compliance.-with County Ordinance No 549. <br /> JOB ADDRESS A CATI N_____ ------------ - -- --------- -- -------- -------------------------------- <br /> -_-----------------_ <br /> CA <br /> -- ------ ----- - ---------------- _ Phone-,-.,/'- -- <br /> Owner's Name Y--- --e—--- ------ ------------------------------------ <br /> Addres4s. 7�_�1;4_1_�.--.-->�-- ----- ------------------------------------------------------------------------------------------------------ --------- <br /> ----------------- : :? <br /> Contractor's Name-------------------- ------------------------ -------------------------------------------------------------- Phone.- <br /> Installation will serve: Resi enceil Apartment House [I Commercial E] Tr6iler Court E] Motel ❑ Other D <br /> Number of living units: Number of bedrooms _� Number of baths -_r__- Lot size ------- ------------------- <br /> Water Supply: Public system Community system El Private D Depth to Wafer Tabl.�� f+. <br /> �_K_ <br /> Character of soil to a depth 6f 3 feet: Sand El Gravel F1 Sandy Loam E] Clay Loam L] Clay E] Adob&ZV'4Hardpan E] <br /> """ <br /> Previous Application-Made: Yes,D No'k New Construction: Yes No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ince from foundation -------;Mj --------------- <br /> Septic Tank: Distance from nearest well,_,_P'L_r Dista -/_ jer) <br /> ------------------ <br /> No. of compartments__..- ---- Size-Z--- -_�Y_40_.Ls quicl- depth, ----- Capacity <br /> Disposal Field: Distance from nearest well.................Distance from found'at ion--------------------Distance to nearest lot line____-_--.___.____ <br /> o1 <br /> r i ----------------------------------- <br /> Number i nes-----------------------------------Length of each line------------------------------Width of french <br /> Type of filter material---- - ------------------Depth of filter material______________ ____Total length____.____________---_-_-___.______.____ <br /> ----- <br /> "Seep ge it Distance to Distance f7n fours fion/61---l- <br /> --_Distance to ne i --r <br /> Number of pits Lining materia ''Size: Diameter----------------- De <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._..,,__._.------- Lining material____--._____. .-_-..__.________.____. r <br /> ❑ <br /> aterial------------- ------------------------ <br /> 0 Size; Diameter--- ---------------------- ------------Depth-------------------------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----- --------- ----------- --I-----------------Distance from . aresf building------------------------------------------ <br /> DDistance to nearest lot line-'----------- --------- - -------- --- --------------------- ---- ---------------------------- ----------- <br /> Remodel t and/or repairing (describe):-- --------- - ----- --- ----- --- -------------------► - <br /> ­.."n------------- - --- --------- -------- ----------- ---------- --------------- ----------- ----------- --- ----- <br /> ------------ ---------- ­ ­-- ------------- <br /> --- --------------- -------------------------------- --------------------------------------------------- <br /> ,7 --iv�l-------- -------------------------- ---------- ------ -- ------ ------- -------------------- <br /> I hereby certify that I have prepared-this application and that the wo w I be done in accordance with San Joaquin Count <br /> Safaws a - rulei and regulations of the San Joaquin Local Health District. <br /> ordinances, <br /> --------- Wrier and/or Contractor) <br /> --------------------------------------- ------ <br /> ------------- ------- <br /> (Si ------ -------- <br /> ---------- ---- --- ------------ ---------------- <br /> By:_--------------------_-------- ------------------- <br /> ---------------------------------------­......-•(Title) 0 : <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla n erse side). <br /> I Z10 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY1__ --------------- ----------- -------------------------------------------- DATE------- ------- --------------------------------- <br /> Y DATE----------------------ii:�------------------------------- <br /> REVIEWED BY----------------------------------------- ------------- <br /> U - ----- <br /> BUILDING PERMIT ISSUED----_------------------- - -------- ----------------------------- DATE--------------Alterations and/or recommendations - ------------------- --- -------- <br /> ------- -------------------------------------•-------------••------------------..---•-----4----•---------------- <br /> -- --------- --------------------------------------- <br /> /_�------- ----------------------------•- ------------•-------------------------•-------------- <br /> - - <br /> ----------------------------------------- <br /> ---------------------------- --------- -------------- ------------------- -------------------------------- <br /> ---------- ----- ------- --------------- ---------------- - -- --------- --- -----------------­ <br /> -------------------- -,-/--------- Q Date.-------:__- ------ ---------------------- --------- ------------------------------------------------- <br /> ------------------------------------------- ----------------- ---_---------- ----------------------- -- <br /> - <br /> ------ ------------- ----------------------............. <br /> .. <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 /> E5­3-ZM 145446 ATWOOD 12-54 <br />