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APPLICATION FOR SANITATION PERMIT Permit No. . .5.. . __ <br /> (Complete in Duplicate) <br /> s Date Issued _____ -—--- <br /> Applica{ion is hereby made to the Sin 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 /> Q ,(� /!l- <br /> JOB ADDRESS AND LOCATION---------��`L�-------��------(;� --:--- ----------------- <br /> -------------------------- •-------------- -- ----------------------------- <br /> Owner's Name-----t•---•. r e, il.Q- -- - ----- -. Phone-----------------------•----_------- <br /> - <br /> ----------------- <br /> Address 1...__ _ <br /> Contractor's Name---------- kf1-----•• _Z -------------------------------------------------- <br /> Installation will serve: Residence �r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __f-__ Number of bedrooms __/__ Number of baths ___/_ Lot size --._________________________ <br /> Water Supply: Public system ❑ Community system Private .❑ Depth to Water Tableo ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ET""Hardpan ❑ <br /> Previous Application Made: Yes ❑ No �` New Construction: Yes ❑ No F4- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_,______________Distance from foundation-------------------Materiaf----.-------.-____.___..____--_____.__._.--__-.. <br /> ❑ No. of compartments--------------------------Size--------•-----------------------Liquid depth-- -----------------------Capacity----------------------- <br /> Disposal <br /> ---------- ------Disposal Field: Distance from nearest well...fk__-W-_Distance from foundation_m-0(0-_..._---.Distance to nearest lot line__ <br /> Number of lines------------f__________________ Length of each line_____ elm�_ -f-____._-Width of trench------.,e��+. ��.._____---__-_.__ <br /> Type of filter material_____1-_Depth of filter material....__/ -____....__Total length___.__._. of _____________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------.....Depth------------------------------- <br /> °-- q\� <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material___.___...__,.__ _..________-_--__.__ '1 <br /> ❑ Size: Diameter Depth - ,. _ Liquid_Capacity::.:>.:-------=_----gals: <br /> Privy• I "' Difro <br />--­­Privy:--- � � -�`-stance" �mnearest i _._____.-_._Distance from nearest building <br /> ❑ istance to nearest lot line----------------------------=------------------------------------------ ------------------------------------------------------------------------ <br /> Remodeling'and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------- .........:-----------------------------------------------------------------------------------------------------•----•-•----•--- •------------------------------------- <br /> ---------------------------------------------------------------F------------------------------------------- ------------------------------------=----------------------------------------•-- ------------------------- --- <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)--•----•--••X1-A-------11� --------S.4� ---- ------------------------._._____ - Contractor) <br /> " ---- (Title)------ <br /> /�C"�4? Z <br /> (Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can be placed on reve sr de. <br /> ARTVENT US ONLY <br /> APPLICATION ACCEPTED BY _ DATE ----------------------- <br /> REVIEWED BY-- ------------------ -----------------•------- ------------ DATE------ --•----- <br /> ------------ --------------- <br /> BUILDING PERK41T ISSUED--------------- -t------------------------------------•--------------------------------------------- DATE.---------------- <br /> Alterations and/or recommendations-------- --------- - - -----•----- --- ------------------------ - <br /> -------------------------------------------------------------------•- ------------------------------ ------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY----- - --- ------ - ----------•---------------- Date---------- ---------- a <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 /> ES_--_9-2M 145446 ATWOOD 12-54 <br />