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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Al. <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit fo`co'nstrucf and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> .. .................. ------------------------ <br /> JOB ADDRESS AND LOQ TION-------------- . . <br /> -------I------2 <br /> --------------------------------------- <br /> Owner's Name---•-- ---t5l)p -.7------ --------------------------------- Phone------------------------------------- <br /> Address.............----------------------------- <br /> At" <br /> Contractor's Name- hone-----------;71 <br /> ----------------------------- <br /> ----------- ----B-4 <br /> ----- -------- <br /> Installation will serveResidence Aparfment House E] Commercial E] Trailer C'Ourf D Motel 0 Other El <br /> Number of living units: Number of bedrooms--- Number of baths _ Lot of s e -------Zs_�4_ <br /> Water Supply: Public system ECommunity system E] Private 0 Depth to Water Table --------- ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel [] Sandy Loam E] Clay Loam [I -ClayE] Adobe Q_-Hardpan 0 <br /> Previous Application Made. YesVo_[_ 'F1 <br /> New Construction: Yes ET—No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic.Tank: Distance from nearest well_9?e_ foundation._-- <br /> %h - - ------Distance frg[n.foun a. � ----A--------- ---------- <br /> EX. No. of compartments----- - --�x---------Size-...,—*37--Xq-.-.2,---�Liquid depfh-------j�_,O........ .Capacity------y .. ... <br /> Disposal-Field: Mstance�from.nearkesf well___301�-----Disfance from foundation__�-_4-!__.Distance to 'nearest lot line_--- <br /> Number of lines----!-------D------------ <br /> -------Length of each line__jb_f7��.U.Wiclfh of french-------2,4 ----- ------ <br /> Type of filter maferiaf---Jr"..__Depfh of filter rnaferial_jt,7. _-------_Total length------715-------------------------I <br /> Seepage Pit: Distance to nearest ---------Disfaric"orn foun'clafion�77/0...''_'_Q stance to nearest lot line___-105 <br /> Number ----------;_Lining material-_00e ...Size: Diameter-------- ----------Depth---------52------I------- <br /> Cesspool: Distance from 'nearest,well-----------------Distance from foundation---------------------Liningimaterial------------------------------- <br /> El Size: Diameter------------ ------I-'.7-.Z:...........Depth--------------------------------- ----------.1- <br /> .1-------Liquid ------------------- gals. <br /> .. <br /> quid.,Capacity. 9 <br /> Privy- Distance from.-nearest well._._--_----___ --------- --------------......Disfanje from` nearest-building=---- ------------------------ -- -------- <br /> ❑ Disfante to nearest lot-line--:.-----______ ---------------- <br /> --------------------------------------------------------------------- <br /> Remodeling and/or repairing des'.cr.ibe)- ----------jr-rj-&74­x4nL- <br /> ------- . ......Pop <br /> -- ------ ------ ---------- <br /> ------------ <br /> ------- ----------- -------------------------------------- <br /> ------------------------------------ ------- ---------------------------------------- ----------------------------�­----------------------------------------------------------------------------------------- <br /> .*�. i <br /> I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County <br /> ordinance laws, and PAYANIG�Agfions of the San Joaquin Local Health District. <br /> Ssp�ic Tvn't Service <br /> (Signed)--9- Va G� Sa. E'dorado NO 2-704& --- ---- r an_d/or Con*racl, <br /> -- -------- ...... .. ... <br /> e <br /> -- ---------------- ---- 2 <br /> id i <br /> -----!At--------------------------------- �6 --- ----- --- ------------ ------------------ ---- -- r and/or Contractor) <br /> Stoclaon, Calif. ---- ------------ <br /> By:.--.­ �?-------------------- ------- <br /> - -- ----------- - -- ------ --------- <br /> --------------------------- ---•----'=---------------- <br /> --- ----------------0---- -- --- -- ------- ----------- --- -(Title)---- -------------- --------- <br /> (Plot plan, showing size Of lot,I location of system in relaflo wells, buildings, etc.,_cal be placed on reverse side. <br /> 4 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------- ----- -- - ----------------------------------- -- <br /> --------------- ----;DATE-------- ---;:------------ --------------------------------- <br /> REVIEWEDBY------------------------------------------ - - ------ --- ---- ------ ---------------- --------------- <br /> BUILDING PERMIT ISSUED------------------r----------- - --- ----- DATE---------------- ----------------------------------- <br /> ---------------------------------------------------------- DATE------= <br /> - -------------- <br /> Alterations and/or recommendations:_------- --- - -- ---- --------------- ---------­---------- <br /> ---- ------------------7-------- ,tom --------------- <br /> --------------------- - - ---------------- - - - ---- <br /> Z)AML ------------------- ----------------- --------------**-------------------­------------------ <br /> --------------- - --- <br /> �7=......... -.0------- --L -- -------- -------------------------------------- <br /> ------------------- --------------- -------_---------------------------------- -------------------------------------------------------%- <br /> ------------------ -----------------------------I-------------------------- <br /> ---------------- ----------------------------------------------------------------------------------- ---------------------------------- ---------------------------------------------------------- -------- <br /> FINAL INSPECTION <br /> --------------------------- ------------ <br /> Date-.... ......... ........ -----—--—------------------------------------- <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 2-s4 <br />