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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> A -ion is hereby made to the San Joaquin Local Health Districtora permit to construct and install f <br /> �pplica4 _hg work herein d ribed. <br /> This <br /> application is made in compliance with County Ordinance NoS4b 7�.c6ft- <br /> 1?L1117 <br /> JOB ADDRESS_At4D LOCATION_. --------Ard Y_ z., ------- <br /> Owner.s Name. .;�C__ <br /> A...... ----------CA2--------!!n---------------------------------------------------------- Phone------------------------------------ <br /> 5 r... ....... ---------------------- <br /> W------ -- -- ---------------- <br /> Contractor's Name--- ------ -------- ----------------------------------------- Phone.,AQ----- _� � <br /> Installation <br /> Q----- <br /> Installation will serve: Residence E] Apartment House [] Commercial E] Trailer Ca- El Motel El Other <br /> Number of living units. --- Number of bedrooms -------- Number of baths,27fot size --------- -------------- <br /> Water Supply: Public,system a,-Icommunify system El Private R Depth to Wafer Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam [] Clay C] Adobe 9?-<ardpan El <br /> Previous Application Made: Yes Ej No 90--lNevi Construction: Yes W,-<o 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p6blic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest w <br /> I ---Distance from found fion---ZO.- ...... Materia3----C ----------------- <br /> No. of compartments.-4------------ ----Sie--,:r ---- - - ---Liqu d epfh_u5__0__"--------Capacity----- -------- <br /> 11__>e i d .... <br /> Disposal Field: Distance from nearest weL1q_ ..'..Distance from foundation___149---/.....-Distance to nearest lot line--- .'._. <br /> �f Number <br /> ine--- <br /> Number of lines------�----------------------Length of each'line----- .....Width of trench-__,2-44!"--------------- <br /> Type of filter material-- Depth of filter material......./A0-------.-Total length--5-7-4----------------------------- <br /> Seepage Pit: Distance to nearest ------Distanc )Tro fo ndation-4_6-------- D' t c to nearest lot line__.______ <br /> A.1 <br /> is a ce <br /> _7 Number of pits------)--------------Lining Size: Diameter-- ..........Depth.../.©._---_________________ <br /> Cesspool: <br /> epth.../--------------------------- <br /> Cesspool: Distance from nearest well-----------------Disfance4rom foundation .......... Lining material______-____---___._.__.______________ <br /> Size: <br /> aterial--,---------------------------------- <br /> Size: Diameter-- -----------­----- - - -- ----Depth---- ------------------- ------------------------------Li uid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well___ _ _ ,__-._._.__.,_---_.-- --- ----------------------- Dista nce from nearest building_-__________--------------------------- <br /> El Distance to nearest lot line--------- -------'-'-'- -wp <br /> g-A <br /> -- ------ -----------------------------------------------------2-L----------------------- <br /> ----.- -- - <br /> Remodeling and/or reairing (ces&j�e):---- -44 ,-- ----------- ---- --------- - - ---- ..... ......e .... .-..- <br /> ......... <br /> ---------- oAle ---- 4 - t4------------------ ---------- - - ---4-----/--0'-----L ...... -------- <br /> ------------ ------------ --------------- -----------4-._----r----r___ -------------_------^---------------------- -- <br /> P <br /> ----------------- <br /> -,. ------- le4 <br /> ....... . ...... ........ <br /> ------------- <br /> I hereby certify-that I have pr6pared this application and that the work will be done in accordance 41"ith San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> DAY&NIGHT 1� A I <br /> (Signed)-----• ------------­SePtk_-Tawk S-erv;ec--------------------- ------- ------ --------- - -------------------------P Contractor] <br /> 1206$0. Eldorado HO 2-7046------------------ <br /> By:.-( W------ ------ ------ <br /> BY= ng size of lot, M <br /> (Plot plan, lofc'% io§'� forn in relation to we buildings,VeJ can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------_------- -- --------------------------------------------------- DATE-----------------e....en % <br /> ____ -------- <br /> Ke j *P <br /> REVIEWED BY----- ---------------------------- --------------------- DATE------------- ------ <br /> ----------------------- <br /> BUILDING PERMIT ISSUED____________._ ----------------------------------------------- DATE_ <br /> Alt0aflons andlor recommendations: A f---------------------- ----------- ----------I.......... <br /> ------------- <br /> ---------- <br /> ...*_K7_ -------------------------------------------- -------------- --------- <br /> =y' <br /> ------ <br /> Vt LJ <br /> ---- <br /> ti-------------------f) t IF <br /> ---------- ---0------------------------i----- ------ ---- - ------ ----------------------------- <br /> ---------- <br /> ------------------------------------v------------------------ --- ------ -------- -------------------- ---------------------------------------- ---------- ---------- <br /> ---------­--------------------- <br /> FINAL INSPECTION BY:---------- C -------------------- <br /> ------- ----------------------------------------- <br /> - <br /> Date.... P <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .130 South American Street 300 We&+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> L5-9-2M 145446 ATWOOD IZ-54 <br />