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APPLICATION FOR SANITATION PERMIT Permit No. __ - _ -•__ (Complete in Duplicate) Date Issued Applica4ion is hereby made to the San Joaquin Local Health District for a permit to c ns uct and in tallIf e work herein described. This application is made in compliance with County Ordinance No. 544. �{' � � �� jr JOB ADDRESS AND LOCATION---�'�- --. ' + ................---�"-'-"`fit--.r -- ------------ IAK Owner's Name s •. = Phone------------------------------------ Address-.-------------- --------••-- --------------------- ---------------------------------------Z------ •-•---- Contractor's Name ` --------�-' ---------- ---------------------------------- Phone-r G� Installation will serve: Residence tt Apartment House [j Commercial ❑ Trailer Court ❑ el F-1 Other ❑ Number of living units: _-1---- Number of bedrooms .' Number of baths _/---_ Lot size -__ _.`r__ .. _. -------- Water Supply: Public. system ❑ Community system ❑ Private 5E� lsepth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 54-<ay Loam y ❑ Adobe ❑ Hardpan ❑ Previous Application Made- Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Tan Distance from nearest well----------------Distance from foundation....................Material------------------------------------------------- No. of compartments-------- ---- ----Size--------------------------------Liquid depth--------------------------Capacity------- --------- Di sal Distance from near st w Qistance from faundatio _- - _:__.Qistance to nearest lot line_---. r Number of lines____ __ ___Length of each line__ _ __ _____________Width of trench.T' -� De th of filter material--...__� Total len t . h--- Type of filter materia P '� g -------------------- Seepage See a e Pit: Distance to nearest wel -------- ------DistanX4_ foundation_.____ ___... istanc�to nearest lo�i�e_____._____._____ P Number of its-- -- ..--Linin material ---- ----Size: Diameter- ----. ---__--Depth------ -.--.------------_----.-- (fi Cesspool: Distance from nearest well-----------------Distance from foundation---------.----------Lining material------------------------------------- ❑ Size: Diameter- ----------------------`-------------Depth_---------------------------------------------------Liquid Capacity-...-----------------------gals. Privy: Distance from nearest well...i--------------------------------------------Distance from nearest building-_---_________--------__-_------_____._. ❑ Distance to nearest lot line----------------------------------------------- ---------------------•- ------------------------------------------------------------------ - Remodelingand/or repairing (describe)---------- --------------- -----------------------------------------------••-•----------------------------• ------------------------._-•------------._... ------------------------------------ -----------------------------------------------------........--------•-••---------......--------•--------------•------------------------------------•------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San J quip Local Health District, , DAY&NIGHT wrier and/or Contractor) (Signed) - ---------------- By:------- 1 .��r_.Els rc�sta---H02-7046----- -- - ---- --- le)---- - ------ ----------�- - = ------------- (Plot plan,.show .. ize of lot, Ioc§ WPs)9VJW"in relation t wells, buildings, etc. can be placed on reverse side). FOR DEPA TMENT USE ONLY APPLICATIONACCEPTED BY--s? ------------- ------------------------------- --------------- ------------------------ DATE _.,.------------- --------------------------- -------- REVIEWEDBY------------------------- � ---- --------------------------------------- -------------------------------------- DATE-i_5------------------------------------------------------ BUILDING PERMIT ISSUED---- ------------------------ ------------------ ---------------------------------------•----• ---- DATE....:7 ."--------------------------- ------ --- ----------- Alterations and/or recommendation's: ------------------------------ ----------------•--••--------------=----------------••-----------�------------------ ..-...------------------- /" ------------ :-- -- ------ --- - - ------ ------ - ----- -------- ----------------------------------------------------------------•--------- FINAL INSPECTION BY:-.,-,4- --- •��'' /------------•-•----- Date----- --_7f .._176/7-------- ------------------------------------- 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 E:F-9-2 M 145446 ATWOOD 12-54