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APPLICATION FOR SANITATION PERMIT Permit No."....2eZ= <br /> (Complete in Duplicate) <br /> Date Issued ---; y-710 <br /> Application 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 Ordi ante No. 649. <br /> / /* <br /> 5' <br /> JOB ADDRESS AND LOCATION--- <br /> ----------------------- <br /> Owner's Name--- ___al� <br /> ------------ Phone------------------------------------ <br /> Address---------S-le ... ------- <br /> ---------------------------- ------------------4....... <br /> ----------------------------------------------------- <br /> ContractorsName___A4_ ­----------------------------------------------------------------- Phone- <br /> Installation will serve: Residenc44-&ra-rtment House [] Commercial E] Trailer Court � Motel R9­6fter [I <br /> Number of living units: -- ----- Number of bedrooms -------- Number of baths -------- Lot size <br /> Water Supply: Public system 4-4;ommunify system El Private E] Depth to Water Table4sP ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe 6-"9_r9pan El <br /> Previous Application Made: Yes E] No2�-�ew Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Noseptic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi <br /> ept�in Distance from nearest well------------------Distance-from' foundation--------------------Material------------------------- <br /> T <br /> No. of compartments--------------------- ----Size--------------------------------Liquid .depth----=-------- ----------._Capacity..----------------------- <br /> ---------------------- <br /> Disposal <br /> ,I F i'la, Distance from nearest Distance from foundation-----9J---------Distance to nearest lot line_--4.?!2---- <br /> a <br /> ---- <br /> Number of lines--------/---------r--------------Length of each line___,�.�------------------Width of french---e--4------------------ <br /> Type of filter maferiaI.__,/.,C- f i or <br /> ,;p--- ----------Depfh'of 9fierial-------I.X!6 Total length-------64_V----------------------- <br /> Seepage Pit: Distance to nearest well/ -----Dis ce om f at ion____?j.........Distance to nearest lot line <br /> a <br /> Number of p;fs-------I-------------Lining ma ria;. ................. Size: Diameter-- ------------Depth__7*4__' <br /> 4cesspool: Distancefrom nearest well----------------- 'sfance ounclafion------------------ Lining material------_------.--___-__----------_---.`T,El Size; Diameter__--_--------------- ----__-------D 4ep ----------------------------------------------------LiqVid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_______________---.- ---------- _--__-----.-Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot fine___-------------------------------------- <br /> Remodeling and/or repairing (describe):-----------------------------------------------------------------------------I-------- --------------------------------- <br /> - <br /> ------------------------------------------------------------------------------------------------------------------------------a----------:-------------------------I------*------1-1-1_-------------_------------------------- <br /> ------------------­----- ---------------------------------------------------------- ----------------------------------------------------------------------------------------------------�t----------------------------------- <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 /> (Signed)_ ---------------tEhnver-s"d�or Contractor) <br /> -------------- -------------------------------------------------------- <br /> By --------------------------- ---------------------------------------------(Titlej--------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- --- ---------------------�< ------------- ---------------------------------------- DATE----- <br /> REVIEWEDBY---------------------------------------------------- ---- ------------------- --------------------------------------------- DATE------- ---------- - ------ <br /> BUILDING PERMIT ISSUED-------------------------­- --- --------- <br /> ------------------------------------------------------ DATE--------------------- -- <br /> Alterations and/or recommendations:------ 'Ilk <br /> N <br /> ----------m�----------------------------------------------------------------------------------------­ __ W_ ------- <br /> ? <br /> ---------------------­- ----------- ------------------------A .\� <br /> ------------------------------------------------------ --- ---------------- <br /> ----------------------- -------- ------ ------------------------------------------------ ---------------------- <br /> it � <br /> ------------------------------- ----------------------I-------- --------- -------- <br /> --------------- ------ --------- ---------------- ----------------------------------- ------ <br /> -------------------------- <br /> -------------------------••----------..-.----------------------- - --- ------------------------------------------- --- ----- ---------:------------------------------------------?�----------------------- <br /> �_J2 <br /> FINAL INSPECTION <br /> -- ------------------- <br /> -------------- ---------- <br /> BY:...... -- Dafe..._��SAN JOAQUIN LOCAL---.HEALTH DISTRICT <br /> 130 South American Street 300 West 0A Street It 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, Cafifoiriie-. Ma'nfica, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 4 <br />