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,f <br /> APPLICATION FOR SANITATION PER Permit No. ..Q--.l. � - <br /> h <br /> (Complete in Duplicate) <br /> Date Issued <br /> .. <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Thisapplication,.is made.in compliance with County Ordinance No. 549. OS-6— 070 "`-5 <br /> R�Q D.��.. f(tw <br /> �o <br /> JOB ADDRESS AND L ATION---- •---- 9 � '�� --. <br /> Owner's Name-------- ----------------- Phone_ �_� <br /> -------- <br /> 1� --------------------------------------------------------- <br /> Address-----•-- '7��. � -------•- -------- - -- - -- -- - •----------...-------•--••--- <br /> Contractor's Name----------------------- V.ltJl14�- -�- ------------------- Phone �g <br /> r--- --------- ' <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer. Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ._I... Lot size -___IoUU_ --__ �__�Q 4-�----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private I�Depth to Water Table �4_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B'Hardpan ❑ <br /> Previous Applicatior9'Made: Yes ❑ No T New Construction: Yes ❑ No Er--- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wellS�f.__ Distance from foundation____a..---_.Material___ -------------------------=' '-----------. <br /> r <br /> [� No. of compartments------.�'�- ---------------SizeS �s6�s <br /> � l -Ld <br /> iquid epth-----'�7�.��-----------Capacity__�0a_o----. <br /> Disposal Field: Distance from nearest wellS----t Distance from foundation---_aS_1......Distance to nearest lot line ----------- <br /> Number <br /> --- <br /> Number of lines--------2-=--------�---------/-� Length of each line---1.4__4."_.----------Width of trench-----o�_zf__-_-.-------_--------- <br />` Type of filter material_-_ .r-_Depth of filter material-._ / .......Total length--------- 04_'____________________ <br /> Seepage Pit: Distance to nearest well_ w_t_.. Distance rom foundation__/_a4-_L..__.Distance to nearest line-, 44------- Q <br /> Number of pits____.__._...__-Lining mate�ial__� -�` --..Size: Diameter...:�9__-_-..____Depth- <br /> �I � <br /> _________________Distance from foundation..__._..... .___.Lining material__.______..____.________.__-_--.____ <br /> _Cesspool: Distance from nearest well _. <br /> Size: Diameter---------------------- ---------------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. <br /> _-_-------------- - m <br /> ---- -Distance from, nearest building------------____------------------------- <br /> Privy: Distance from nearest well--- <br /> ❑ Distance to nearest lot line---------------------------- ------ ------ ---------------------------------- - ----------------•---------------------------•------------- - <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------•----•--------•--------------•-------------•------------- <br /> ra. :- -- ----------------------------------------------------- <br /> ------------------ ---- ----------------- ------------------------------------------------------------------••----------•-----•--•---------...-------------------------------------------•----------- <br /> F 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, d rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------------------qdL4_44_1k---------S_2,�_f----------- ----- ----- , wrier and/or Contractor) <br /> B ' F ------- -�?� ---------- •----------------(Title)----- •-------------------- <br /> a Y•- <br /> (Plot plan, showing size of lot, location of system in relatio0o wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -------------------- -- ------- ----- ------------------------------------------------------- DATE----- ----------- <br /> --------- ---------------------------------- <br /> REVIEWED Ry <br /> REVIEWED ---------------------------------- DATE •-------------------------•-------------- <br /> ------------------------ <br /> ---- <br /> DATE------ <br /> BUILDING PERMIT ISSUED--------------------------------- �-`----- ------------------------------------------• -----:----._• , <br /> Alterations and/or recgm endations: ,f --------- ---- ------------------- <br /> ---- �--- . <br /> ---------------- <br /> i ------------------------- 0��----------- T --------- - ---------------­---------------------------------------------------------------------- <br /> --------------------------------------------------------- <br /> -------------------------------------------------------- -------------------------- <br /> i <br /> FINAL 'INSPECTION BY:. <br /> --- -• ----------------- ------------- Date---- . ..:�[..~-`------ b <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 /> E�- g 14Sg46 ATWOOD F <br />