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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica4-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 /> 9 1? <br /> JOB ADDRESS AND,LOCAnY OWT�-------------- -------•4�-------- -- ----- <br /> Owner's Name---oel21-0-1...A_...._ ------ ---- --------------------------------------------•--- ----- ----------------------------------- Phone.-----------• ---------------------- <br /> 'Address------------------------- -----------------------------------------------------•--•-------------------------------- <br /> Contractor's <br /> ------­­-------------------------------- <br /> ---------------­----------- ------------------­­------------------------------------- <br /> ---- Phone----------------------------------- <br /> Contractor's Name-- n ------ ------------•--------------------------------------------- ------------------------------------------ <br /> 7------ <br /> Installation will serve: Residence 1� Apartment House E] Commercial E] Trailer Court [] Motel J_ Other <br /> ❑ <br /> Number of living units: J------Number of bedrooms -07-. Number of baths !�n__ Lot size -_________________________ <br /> Water Supply. Public system El i Community system 0 Private R!] Depth to Water Table r0__ ft. <br /> Character of soil to a depth of 3 fee+: Sand F] Gravel [-] Sandy Loam.] Clay Loam E] Clay E] Adobe L] Hardpan El <br /> L I I <br /> Previous Application Made; Yes Ej No& New Construction: Yes Z No 0 <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: <br /> 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> nk: Distance from nearest well________________Distance from foundation-_.___________.__-.0Material_-___.____________________________-----_.__------ <br /> No. ocompartments----- --------------------Size----------------------------------Liquid depth-----------•--- ----------'Capacity----------------------- <br /> tCapacity----------------------- <br /> t <br /> f 1 0 .4 . <br /> Disposal Field: Distance from neareit well---. Distance from foundation__'*-_-._..__.Distance to nearest lot linel------------- <br /> ----------- ---- <br /> Number of line.--------------- -Length of each I i Width,of trench----;_Y I--------------------- <br /> Type ol filter maferial__/_;,_A�W-'----DePth of filter material---/_j----------------Total length__/_&_0----------------------------- <br /> .. <br /> Seepage Pit: —Distance to nearest well-----------------------Distance from foundation--------------------Dista6cejo nearest lot line_.__-._________._ <br /> ❑ Number <br /> ine-------------- <br /> Number of pits----------------------Lining material-----------------.-----Size: Diameter-------------!_--------Depth--------------------------------- <br /> Cesspool: Distance from':nearest well________________Distance from foundation--------------------Lining material-_"_...,_.___._______-__________-_. .� <br /> [� Size: <br /> aterial--------i--------------------------- <br /> Si70.- Diameter"------ ----- ------------------------Dept h-----------------------------------------------------rq.a Capacify_-------------------------gals. <br /> :-_Distance.from--nea- sf� <br /> P F17Y well' <br /> ElDistance to nearest lot line---------------------- ------- ------------ -- ----------------------------------------------------------------- ------- ---------------- <br /> 6 <br /> Remodeling and/or- repairing (desc.ribe):---A94449;rh--- x .' '--------•-----------------------•-••--------------------- <br /> ------------- ------------------------------------------------------------------------------------------- <br /> ................ ---------------------------------------------------I------------------------------ <br /> .. 4 1 ------------------------------------------------I---------------------------------------------------------------- <br /> -------------------------------- ----W-1----------------------------------------------------------------------- <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 /> --------------------------- ------- -- c tor) <br /> (Signed)--- M IASM� _00 -.1...... 1 - -(Owner and/or Contra <br /> , - . <br /> _0------------- <br /> By:..... -------------------------------------- <br /> /-- <br /> - --- A4,. ;j------- <br /> (Plot plan, showing size of lot, loca-fion of sys+gm- in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED, BY_ - -------------- ------------------------------------------- DATE--- -------------- --------------- <br /> REVIEWEDBY------------------------- ------------------- ----------------------:---------------- -------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------ ------------------ -------------------------------- ------------------ DATE-------------------------- -------------------------------- <br /> Alterationsand/or recommendations:.---------- ----------------- _­----------------­-------------------------------------••--------------------------------••---------------------------- <br /> ----------------------------------------------------------- ----------------- -- - --------------------------------------------------------------------------------I----------------------------------------------------------- <br /> ----------------------------------------------_----------------------------------------- <br /> --------------------- ------------------------------------ ---------------------------------- ------------------------------------- <br /> ------------------- <br /> ----------------------------------------- ---------------- -----------------------__---------- ----------------------------------- ----------------------------- -------------------------------------- <br /> ------­------------- --------------------- ------------------------------------------------ ------------------ -------------------------------- ---------------------------------------------------------------------------- <br /> / - <br /> FINAL INSPECTION Date... ------------------------------------------ <br /> --- ---- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 360 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California' Lodi, California Manteca, California Tracy, California <br /> 145446 ATWOOD <br />