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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .._ S�s�3 Applicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCATION---------�/--� ---� - +� I `�f� -COPhon ---- - Owners Name------- '.-__-_.-.� - - - -- -•- ----•---- -------- - ------ -------------------------- ---------- `'� ,�.;� -. _`_ W ContractoAddress. rs Name_----------------r�� .�_ - Phone_170_7.Z_�f__.--_ f! ! SY; k ------------ - Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court [:]--,Mot, ❑ Othe ❑ Number of living units: J-___ Number-of"bedrooms A- Number of baths 1-_---- Lot size 2 --- x._a --------------------_--_ a Water Supply: Public system ❑ Community syste#❑ `Private Depth to Water Table Character of soil to a depth of 3`feet:l Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6ejff Hardpan ❑ f �A Previous Application Made: Yes ❑ . No�*�New Construction: Yes E] No r TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i 1 apt' Tank: Distance from nearest wal!___.-------____Distance from foundation------------- ------Material No. of compartments------- -----_----- ---Size------••------------------------Liquid depth--------------------------Capacity------- ----- Disposal Field: Distance from nearest well--- --_._-Distance from foundation--------------------Distance to nearest lot line ❑ Number of lines----- - Length.of each line-•--------------------k-------Width of trench--------- --------------------- 3 r. T e or filter material------- ` __- Depth,of{filter material-___-.-----_ �_`----Total length__----------------------------------`-- ------ S6&pa e Pit. Ditance to nearest,welL. r of its.----`''---•------- •inm m31 Dt raal@�.ince foun anon----f-`'-•----•• Di�a ice to Deptnst_I��--- -__�0---�-- Ld' \ Numbe p g - � ize:'Diameter---�--. 9 -----------------------�------:---.. �I Cesspool: Distance from nearest well---_--__---="'�_Distance from foundation ._-..__ Linin material Size: Diameter----- -----=----- �==::Deotlt ---------------------------------------------1---- Liquid Capacity-. gals. Distance from nearest building---------------------------------- --- -- Priv Distance from nearest well --------- - -, --- -'-.•------------------------------------ - ----------------------- r Y ❑ Distance to nearest,lot line-----------------------------•----------------------------•------- Remodeling acid/or repairing (describe):--------- ------_-------------------------------------------------------------------._--------•--•- \j\ ---------------------------------------- kr. t -------------------------------- ------------------•-•------------ ---------------------••-----------•-----------•-------------------------------------t7 } f ' -------------------- -------------••--•-----------••-•------•---•----------•-------------••---------------------------- ( I hereby certify that I have prepared this application and,that the work-will be doneIin accordance with San Joaquin County ordinances, State laws and rules and regulations of the San'Joaquin Local Health District. ' ----------- ------ - norl�r Contractor} (Signed)----- -- --- ---------•---p--�-- --_ - -- - -- ------------------ f !.!/ T��l --------------------------------------------•----------------(Title}--. ----- x (Plot plan, showing size of lot, locatioof system in relation to wells, buildings, etc:, can'be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ------------ ----------- ---------------------------------------------- DATE----........;;------------------ { ------------- REVIEWEDBY------------------------------- -------------- --- --------------------`. _ ------------------------------------------DATE: ----------------------------------------------- ---------- - - - - --- ------------ DATE - - �- ... BUILDING PERMIT ISSUED----------------------- ---- ° l i Alterations and/or recommendations------------------- -- - ----------• -- - ---------------•--•--•----- ---•-----------------------------------•------- ----•- ----------------------------------------------------------•-----------•--•---•--------•-••------;�---------------•-•--------- --------------------- k ------------------- ------------------------- •'--------------------•---------------'--------------------------`--------------------------------------------------------------------------------------------•----------------------- ----------•-_-----.----•_-------.-.-'---------------------••-- - ..-.--..._.--"--.-. "--. _•--.-----_._.-.------•__- --.-.-.___--___----.-.--:__-.-.-----__-_------.-:--------_•--------------•__--- FINAL INSPECTION BY:--- - - � =------- Date. ------------- -- ---- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT q 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E6-9J-2M 145446 ATWOOD 12-54