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a �2- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ____-•-_�.r_.-.............. <br /> l-.�;�� , I Tie, fAI pro �, Date Issued �� <br /> A p i��'is &rie y1ma a 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 /> � , . <br /> ---------•---------•-- <br /> JOB ADDRESS AND LOCATION.---- �--I)-- -- -�7�•---r'�--'-.Z.�j--�•►A��_4-j�f.�_.. ------------------------------------------- ---- - <br /> Owner's�Name-----A._-►fit------ -`' --------------=------------•------------------- --------------------------- -------------,..,Phone-----'4_�j-3-------------- <br /> Addressi ... { � _ __f_. _ =-------------•--------••-•--------••---------------.-----------------------on ----------------------�•--•--- <br /> ., <br /> A <br /> Contractors Name_ UA..f--_A-m- _=_.-_--- •--•---- <br /> --------------------------------------------------••---------------------------- Ph a -•- --�--3� ------ <br /> Installation will serve: Residence N,-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __$____ Number of bedrooms -'Z-- Number of baths _!____ Lot size ____.-------------------------------------------------------- <br /> Water <br /> 0___ __-----------_____________________________Water Supply: Public system ❑ Community system [I Private Depth to Water Table - it. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam ❑ Clay E] Adobe Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes o ❑ _ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well---------._------Distance from foundation--------------_----Material______..____._______________-.--___________... <br /> No. of compartments------------------- ------Size--------------------------------Liquid depth--------------------------Capacity----------------------- J <br /> Disposal Field: Distance from nearest well_________________Distance from foundation.___________..__....Distance to nearest lot line_............. <br /> ._ .� <br /> Number of lines-----------------------------------Length of each line-----------------------.-------Width of trench----•------------------------------ <br /> Type of filter material____________________---Depth of filter material-_.______...._______Total length------------------------------------------ <br /> Lf.-.Distance to nearest lot line-- <br /> i ne__ =� <br /> Seepa Pit: Distance to nearest well_.�_D�___..........Dista from foundation_ Depth _____ <br /> Number of pits__..%_____..______Lining mat'eria'" _i a-115ize: Diarnrer_____-O_.... . _ <br /> Cesspool: Distance from nearest well----------------- from foundation___.________._.._._ Lining material_.__------_._._._.._.____________- m <br /> ❑ Size: Diameter----------------- -- - --------------Depth--------------- -------------- ............ Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_____ __________________------- -------------- from nearest building .____._.____._- �r <br /> ❑ Distance to nearest lot line------------------- ------------------------------------------•-------------------------•------------------------------------------------- = <br /> Remod lin and/or repairing (describe):____ '` --- •- --- ----�� ----- -- <br /> 1h <br /> ... - - <br /> _____________ °_____.._.________________ - <br /> ---------------- •-----------•-------------------------------------_----•- ----------• -_- <br /> '_ ------------------- -----------------.----------------' •-------------------------_- ._ <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).. - ------------ -•----- --------- -------------------------------- ---------- --------------------------------------------------------=-------.(Owner and/or Contractor) <br /> I3y:. -- ------------------ -----.-------------------------------------------------------------(Title)---- '�- _ •---------•------ ------------ <br /> (Plot plan, showing size lot, location f system in relation to wells, buildings, etc., can be placed on rrse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-�Qi------- ------------------- ------- - ---------------------m -------------------- DATE��--------------------------------------------------------- <br /> REVIEWEDBY-------------------------- -- ------- ---------------------•-------- DATE ---------------------------------------- <br /> BUILDINGPERMIT ISSUED------ ------------------------------------------•-------- ---------------------------------- DATE.----------------------------------------------------- <br /> Alterationsand/or recommendations-------- ----------:-------------- ---------------•---------------------------------------- -----•---------------_--------------_- -----•-- •-------- <br /> --- --•--•----•-- - j -------------_._ t <br /> �=- - <br /> --- --- ------ - -.. G <br /> .-- <br /> ------------ --•---------------------------- ----------------- <br /> ------------------------- ----------------------------- ------------------------ ---------- •- ------------------------------------ -------------------------------------------------------------------------------------- <br /> FINAL,.INSPECTION BY:... ��-------------------------------------- Date__ ---------- .___---- <br /> i <br /> ~ _ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 130 South American Street 300 West Oafs Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES^9-2M 145446 ATWOOD ,2-54 •,/ <br />