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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) r H w — DateIssued --- o�g_ dsa--a / Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th"35�is apilication is made in compliance with County Ordinance No. 544. ! I r� .o E• f-E��c w , T(_ _ JOB ADDRESS AND LOCATION_--_-- ------�[��►�"-----_-�-- _�_,�_.C�..� ._.��,,Sa../____��'.,�__CoN��e�+�---.��1'��- -l1 f��t Owner's Nan1e -----•-•----------------J- ----------------------------....._._. Phone,lT )ld'tt AddressA j : .t.- ---•--------------••--------------------- - ------------------ Contractor's -- --- ------ Contractor's Name.. _ as!J" 4 -f - C2�i =--- --• -- - --- ------------ Phone---��P�_. fn'stallation will serve: Residence [Apartment House ❑'.Commercial ❑ Tr •Ier Court El Motel ElOther ❑Gt1�1 ole-R Number of living units: _.� '`� l i D _ _- Number of bedrooms _ Number of baths ________ Lot size — art _s __________________-______..________________- Water Supply: Public system 1I0 'Community system Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑=-Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No [R�New.Construction: Yes ❑ No ❑ /;_-e;l e. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200'feet.) y pticT ~' '' Distance'from riea�est well__'-- ."----:^"Distance from foundatioh_ ~�-�M tefial___ b No. of compartments. .__.__... Size-_______.___- -,--Liquid depth --------------- -.----Capacity os el'd: Distance from nearest well-------------____Distance from foundation----------__--------Distance to nearest lot line___,.--_____--__ Number oi'lines------------------- ------------Length of each-line_-__-__-, --=-----:-----Width,of trench-------------------------------__-- Type of filter material ____ ------------Depth of filter material---_----------.-------Total length___--________________---_______-______-- of Seepage Pit Distance to nearest weft_--.._._ .......Distanc orri,fo ridation_ 1�______Distance to nearest lot Erne__; ____ [�✓/ Number ------ Lining t _ Size: Diameter,,: c ___Depth-_ 0 Cesspool: Distance fo;om nearest well_________________Distance from foundation------------------ Lining material__.____._____.---------------------- El.— ____._.-_____--___-_ Size: Diameter_ = Depth =___ r� ;� _._: Liquid Capacity ,; y gals. ❑.� _ Privy: Distance from nearest welLr________________________-_____._- ..----Distance from nearest building r ., . 9 ------------------------- ❑ Distance to nearest lot�line --__:_ -------------••-------------------------- Rm eling nd/Or repairing (Describe):,---------."-------------------- -- .---------- ---• 's ' �'" . ° _ ------------ ------------------------------------------------------------•---------------------------------------------- --•-----------------------.-----------------------------------------------------------------' I ----------------her -- -- •------'-------------------- -----------•--------------`--------•-----------------------------.-•=---------------------•---------------•-------------------------.----- 1 hereb cerDfh, t l hive`prepared is-a-p- and that the work will be done in accordance with San Joaquin County ordinances, Still and^rule' and regulate of the San JoaTi� th District. Si ned - i/�Contractor) ( g ) .. -' By----------- ----j1fi6n4o_'wel1i,,-,6uiId -----ti'.3- (Title) I? -•- - - •�--�-------------------- (Plot-plan, showing-size-of-lot Jocation of system in--rc.,-can,.be.placed•,on reverse�side).�:.:A.-� FOR DEPARTMENT USE ONLY _ y APPLICATION. ACCEPTED BY�--- ------------- ------ ------------- ---------------•----- DATE,�.:� --------------------------------------------------- REVIEWEDBY - --- -- ------- - --- - -------------------------------------------------------------------------- DATE-- BUILDING ATE-BUILDING PERMIT ISSUED----------- -- - -------------------------------•----•--•------------------ ------ DATE l -------••----- Alterations and/or recommendations--- --------- ------------------------ - - ----------------- (rN ------------------------------------------ ------------------------- -------------------------------- -------------------.----------------------------------------- ------------------------------------------------------------------------ -------------•------------------------------•--• ------- ----------------------- ------...---------- ----= c ------------------------------------------------------------------- ----------------------------- - --------------------------- ----•--------------.............. ------------------ ---------------- ----•-----�--�""-,_ FINAL INSPECTION $Y., .-------- Date.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 14s446 ATWOUD 12-54