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........................ <br /> o <br /> 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 coristruct and install the work herein described. <br /> This applicationis made in compliance w• h county rdinance No 549tl� <br /> --- --------- <br /> ......... <br /> JOB ADDRESS AND C6QC,2ON--41--------- ---- - -------- <br /> -01-------- Phone------------------------------------ J, <br /> ---------- ------- --- --------- ---------------------- ---- <br /> Owner's Nam ....... _LZ ... I'- x 7 < <br /> -------- ........2,21------------ V-------- ------- 4 -----''------------ <br /> Address__ <br /> -------- .... <br /> ----------------------- --- ------------ Pkone.,F-./—----------— ------ - <br /> Contractor's Name------------------------------------- ------------ - 7-- <br /> ❑ <br /> Installation will)serve: Residence X Apartment House 171 Commercial E] Trailer Court 0 Motel [_1 Other <br /> J-_-`Number of baths -1----- Lot size ......717X-1,21S -------------------- <br /> Numbe <br /> Water <br /> of living units: ..__.__ Number of bedroomsWater Supply Public system 09---,Community system 17-1 Private,❑ Depth to Water Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand n Gravel [] Sandy Loam El Clay.Loam [I Clay El Adobe)X Hardpan E] <br /> Previous Appl i I cation Made: Yes E] No New Construction: Yes LK No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .11, ewer is available within 200 <br /> (No septic tank or cesspool permitted if public s feet.)Septic Tank: Distance from nearest well-_; foundation__._..__..__.._.__..Material___...__------------ ----------------------------------- <br /> --------------Distance from,foundation--- ------ <br /> ❑ <br /> ------ --Liquid clep�h.----------___--------Capacity----------------------- <br /> No. of compartments------ -------------------Size--------------------- <br /> Distance from foundation-_-._--_._____.__.Distance Distance to nearest lot line--------­------- <br /> Disposal Field': Distance from nearest well__.____..__.__ ------- -----------Width of trench--------------- <br /> ---------Length of each line--------- I I---------------------- <br /> F1 Number 'of,lines-------------------- - -------Total length____------------------- ----------- <br /> Type of filter material-__.._______-._______._Depth of filter material-------------- - <br /> Distance to nearest well--.------------- <br /> Seepage Pit: is well______________________Distance from foundation--_----------------Distance to nearest lot line...__.______.____ <br /> epfn ----- --------- --------- <br /> El <br /> Number of pits----------------- ----Lining material--------- --------------Size: Diameter----------- ----------D <br /> __; -------�:_t <br /> E. <br /> nearest-welI__,0%47V_--_'Disfanc� from foundation----/0----------Lining material <br /> ---------4 <br /> Ce 001: Distance from /,z, i --Liquid Capacity-Z --------gals. <br /> Size: Diameter-- ------------------------Depth---- ........ <br /> Cess <br /> nearest building.___-------------------------------- <br /> Privy: Distance from nearest well-_____-__.___.____--__._ <br /> --------------------­­--------Distance f <br /> -------------------------------------------------------------------------------- ------- <br /> 0 Distance to nearest lot line__--_------------------;��------ <br /> S7 '---- <br /> Remodeling .and/or repairing (describe):------ ---------- ---------------- . . . ....... --------4--- <br /> ------------ <br /> jjp -------------------- - -- - ------------------------ ------- - --------- -------------------- ...... <br /> ----------- ....... ........... --------------­--- <br /> -------------- • <br /> ---------- <br /> ------ ------------------­--- ....... <br /> --------- ---- --------- <br /> - <br /> ------------------- ---I-_ -- this application and that the work will be done in accordance with San Joaquin County <br /> I hereby cer that have prepared <br /> ordinances, Stat a an rulesand re i I tions of e San Joaquin o I Health,District. <br /> ' <br /> _J------ --- ___-(Owner and lor Contra r) <br /> (Signed) <br /> (Title)- ------------------------------ <br /> "-n reverse side). <br /> --- - ---- ---------- --- <br /> buildings,By:--- ........ ------------------------ <br /> elation to wells, bui ngs etc., can be place <br /> (Plot plan, showing size of lot, location of system in r <br /> FOR DEPARTMENT USE ONLY <br /> ' � DATE9--Q�_N-p--.-- <br /> ----------------------------------------------------------------------------- <br /> - <br /> APPLIC...A..T.. <br /> I � N ACCEPTED I --�--- ----------- ------------------------ <br /> ----------- --------- <br /> ------------------------------------------------ <br /> REVIEWED BY DA <br /> TE <br /> BUILDING ERMIT ISSUED ----- - ---- <br /> ----<----;-N-------------------- <br /> -------- -------------------.-..--.----.--.----- <br /> - <br /> ....... ---------------- - DATE <br /> Alta ''and/or recommen aticns� _ . ... <br /> - -------------------------------------------- ---- ------- ---------- --- <br /> ------------- ------ <br /> -------------------------------------------------------------------------------------- <br /> -- ----- --- <br /> -- --- ------------------------ ------ -_------------------- -----------_----- --------- <br /> -- --------- <br /> Date------------------------------------------ ---------------------------------------------• <br /> FINAL INSPECTION BY--------------------------------------- ----------_------------- -------------- --- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sough <br /> 1h American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 11, Lodi, California Manteca, California Tracy, California <br /> Stockton, California <br /> E '145446 ATWOOD <br />