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' Permit No. ___.!C_-5-----------� <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) / <br /> bate Issued <br /> Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construe inst <br /> an all the wad k herein described. <br /> This application is made in compliance with C unt Ordinance No. 549. � ` <br /> t f t 3 S a� sT f .t I <br /> a i �, <br /> JOB ADDRESS AND LOCATION __ � --.---- <br /> -�`` Q '' �' c,{ _ rte---.-_�J '�.l 't'a-�/ <br /> ��" ... Phone <br /> Owners Name---------- 4. <br /> f <br /> ---•-------`-- --------- <br /> Address-_ --�-- ------ <br /> r1� . Pho - 1 . <br /> II- <br /> Contractors Name------- ---Installation will serve: Residence [�:Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel Other E] <br /> <- <br /> Nu bar of bedrooms _, _. Number of baths .�--- Lot size ____---� � �-"'� <br /> - -- ----- --------- <br /> Number of living units: __ .�-- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_ ft. <br /> Character of soil to a depth of 3 feet: SVN- <br /> ravel ❑ Sandy Loam ❑ y Loam❑ Clay-07:3-AT—,be ardpan ❑ <br /> ion Made: Yes Noew Construction: Yes No ❑ <br /> Previous Application ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public seww is available within 200 feet.) <br /> �•GV,44� f�-----•---.Mate ai__ w_(_" � ---------------- ---------- <br /> Septic Tan Distance from nearest wel istance froTIJI,un < n__ -._ r <br /> No. of compartments----, ydepth P Y - <br /> Size---- `�--�-,f1 -------- <br /> --:'Liquid ._._ _--- --- Ca ac,t _.. _ <br /> ...._,-._Distance from foundation_IZ- -1----•Distance to nearest lot pa--Cr---_-_.- <br /> Disposal Fie Distance from nearest well •.fi�rr <br /> ❑/ Number of lines-----An;-W -.-- - ---- --Length of each line__-_.E(- ------�,,.---.Width of french. ----------------- <br /> Number <br /> of filter material__ _, #�.� zr epth of filter material---`--- ------ To+al length-------- .�-------- -----•------... <br /> 5eep❑aqe Pi <br /> Distance to nearest well_ G� ' ''�--.-vistanc fro u ation__t1fll-_____.Distance #o nearest lot linel_o, ----- ice, <br /> Number of pifs.-.._�f -'- -Lining material.._-`------ -- <br /> S�Sae: Diameter---__'3_ - --- <br /> Depth- L <br /> Cesspool: Distance from nearest well-----------------Distance from foundation- ____ __.___Lining material ----- ---- -------gals. <br /> ❑ Size: Diameter------------------- ---------- ------Depth----------------------------------- -------- -----Liquid Capacity---------------------.----- <br /> Distance from nearest building------------------------------------•---- <br /> Privy: Distance from nearest well-...__._..___---_------ - ---------------------- <br /> Distance <br /> -- ------------ <br /> ❑ Distance to nearest lot line----------------------------•------ ---- -------------- ------------------------------------ <br /> Remodelin and/or repairing describe :-----------✓ <br /> ------------------------- <br /> t° '''----"------------------------------------"--"------- ----••---------- ------------------------------------ <br /> ---- - - <br /> -"-- ------ ------ -- - ----- - ---- <br /> I hereby certify that I have prepared this application and+ hat the work will be done in accordance wi <br /> IJ th San Joaquin County <br /> ordinances, State laws, nd rules and r Mations f the San Jo gain Local Health District. <br /> ordinances. <br /> nd/o Contractor <br /> :-y --- .----- ----- -- 1 <br /> Ss ned -• ----- --- <br /> ( 9 ) <br /> . �. -------- (Ti+IeI irJ <br /> r --•- 'e- _ ---•--- <br /> By:-••-- buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relation to wails, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ------------------------- ------- --------- f-- --.- ----•------- <br /> --------------- DATE-----------= -s'`--------- ----------------- <br /> REVIEWED BY----------------------• --------------------------------------------- --------------------------------- -- <br /> -- -----------• DATE----------------------------------­---------------------- <br /> BUILDING PERMIT ISSUED----------------------- ------------------------------------------------------ <br /> DATE-------•--------- ---- -------•• ---• ---------------------- <br /> Alterations and/or recommendations----------------------- - -------------- ----- <br /> -------------- <br /> 11 <br /> 5 Date------- -- -------- <br /> - ------- <br /> FINAL INSPECTION BY------------ --- ------------ ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 Wast Oak Street 132 Sycamore Street 814 North ••C•• Street <br /> 130 South American Street Trac California <br /> Stockton, California Lodi, California Manteca, California y� <br /> E.-9-2M 145446 ATWOUD 12-54 <br />