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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> ____._J__�_.�f_____ <br /> A 0 F,5— 2-06—a-,v d' <br /> T�plica�ion is hereby made to the San Joaquin Local Health District for a pprmlt construct and install the work herein cles5l�i e <br /> is application is made in compliance with County Ordinance No. 549. <br /> 9 (1-5 <br /> JOB ADDRESS Al� -- - ------- <br /> N ------ --------------- <br /> - <br /> Owner's Name---------------------------------- <br /> -—----------------------------------------- -------------------------------------- Phone---------------------- -------- <br /> Address---_------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name- ------------ --------------------------------------------------- -----------------------------------7------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 4�;�rfment House E] Commercial E] Trailer Court E] Motel E] Other E3 <br /> Number of living units: Number of bedrooms*__3__ Number of baths _mrLot size ----------------------------- <br /> Water Supply: Public system El Community system E-] Private [5--Depth to Water Table J7_9ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam E] Clay [] Adobe 6--Hardpan E] <br /> Previous Application Made: Yes E] No 4—New Construcfion< Yes 4-4&-9- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4W f e <br /> Septic Tank: Distance from nearest well 4�-----------Distance from foundation-----A�---- Material--- ------ <br /> -A— 9 <br /> 4— No, of compartments - ------Liquid clep�h_,e/----Aw --------Capacity---- ----- Z <br /> Disposal Field: Distance from nearest welf-/I?d-1- -Distance from foundation----1_�__!__._.Distance to nearest lot line---S-20----- � <br /> Length of each lin------- ----__-.._.Width of french----- ------------------ Nn <br /> EZ-- Number of lines----------.2— -e------ V% <br /> Type of filter maferial__.__/___;_____________Depth of filter material_.. _ ____._.__.Total length----Y_8_0_0------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line____._-_--___.-_ <br /> ❑ <br /> ine---------------- <br /> El Number of pits---------------------Lining material----------.------------Size: Diameter-------------.------_Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_______-------_..____.______________- f <br /> ❑ <br /> aterial--- ---------------------------------- <br /> El Size: Diameter------------------------------ -------Depth--.-------------------------------------------------Liquid Capacity--------------------- gals. <br /> Privy: Distance from nearest well.............._-.-.-_--.-.._.__---__._---_.-..-Distance from nearest building.____.___---- ---------------- <br /> El Distance to nearest lot line-- - - -- ----------------------------------------------------------------------------------------------------- ------------------------------ <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------- --------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------- <br /> ------------------------------------------------------I-------------------------------------------1---I-------­­....I.......I...--1----I.....--­--------------------I----------------------------------------------- <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 f the San Joaquin Local Health District. <br /> (Signed) I -__ 7Z�-------------------------------------------------------(QwneAwmuV.Qr Contractor) <br /> ------------------r------- <br /> 1�y ......... -—-----------------------------------------------(Title)---------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, e+c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---------- ----------- ------ ---- ---------------------------------------------------------- DATE-------------------------- --- ------------ <br /> ---------------- <br /> REVIEWED BY--------------------------------- DATE------------h------------------------------------------- <br /> BUILDING PERMIT ISSUED----------- DATE------ q T------------------------------- <br /> Alterations and/or recommendaflons:.------ ------ --------- ----- -- ------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------- -------------------------------------- ...................I-------------------------------------------------------------------------------------------------------------------- <br /> ---------------- ----------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------- <br /> ------------------------------ ---------- ------------------ -----------� ­- -------------- --------- - ------------------­---------------------------------------------------- -------------------------------- <br /> -------------------------------------- - ------­------- --------------------­ ------ -1------------- ------------------------- ------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY Date---------------------------- ------------------------------------- <br /> ------------------------------ <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 Lod;, California Manteca, California Tracy, California <br /> ES---9-2M 145446 ATWOOD 12-S4 <br />