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APPLICATION FOR SANITATION PERMIT Permit No. ..7Z61-. _ I (Complete in Duplicate) Date Issued e Applica+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_ 0-- -..---. C'----- .... ..--------------- Owner's Name------ -r"us.1a.---------_!_!_1---------- ---_-W --W. ---••--- •------- ----------------. ----.. Phone.----------------------------------- Address .-«- °��-.- J -• I c r ......a ��r�fpr: !_f_ r$ ; ---------------- Contractor's Name----- �r . _ _i.______Q_ ._ -------------------------------------------- Phone,/ Installation will serve: Residence 9/partment House ❑ Commercial ,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: l._-.- Number of bedrooms __-- Number of baths __f-__ Lot size __-_-_.o� - -- -��---------------- Water Supply: Public system &-Iommunity system ❑ Private ❑Y Depth to Water Table _cP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam [3 Clay E] Adobe�ardpan E]Previous Application Made: Yes eNo ❑ ' Ni Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS-, ... Noseptic tank or cesspool permitted if public sewer is available within 200 feet.) S is Ta k, Distance from nearest well _____�.7._4__Distance from foundation------------------ Material------------------ ._. .--- � No. of compartments-------------------------Size--------------------------------Liquid depth.----------------------- -Capacity----------------------- Disposal Field: Distance from nearest weli: -----------'_Distance from foundation--------------------Distance to nearest lot line----__----.-.._.. Number of lines---------------- ------------ -'.- Length.of each line----`------ :-----------.Width of trench-..------------------------------- Type of filter material-__________ _ Depth of filter material----------------------Total length--------------------------------.-____-._- eep Pit: Distance to neare t well----- ----------Distance m- {oundation--- /�.r__.Distance to nears t I lin S� �__ + da Number of pits-I' Lining material--------------.------Size: Diameter_J�o �0------Dept'n Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-_._.___----__.--------- Size: Diameter-------i----------------- -----De th----------------------------------------------------Liquid Capacity Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.-----.---------------------------------- lk ` ❑ Dis$ance to nearest lot line----------------------------------------------------------------------- --------------------------- O Remodeling and/or repairing (describe) ----------------------------- - ---------------- I --- ----------------------------------------------------------- --- ----------------------------------------------------------------•---•------------------------------------------------------------------------------------- ------------------------------------ t I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Jo in Local Healt District. DAY&NIGHT (Signed)------ -------------Septic-Tank-Service--------------------- ----- ---- -- -- --- - - Contractor) 1206 So.Eldorado NO 2-7046 pa4� BY=---- --------------------- - - --- --- -- -------(Title)- tom --------------------- ill (Plot plan, showing size of lot, oca ion o sysfem in relatio wells, g p ) buildin s, c., can be laced on reverse side). h 1 r FOR DE ARTMENT USE OKILY APPLICATION ACCEPTED BY---- ----•-- ...... ----- ------ --- ------------------------------------------------------- DATE------ - - -- ------- REVIEWEDBY-------------------------------- -€ ------ - ---- -- ------------------ -------------------------------------- DATE------ -- --------•-------•----•------- BUILDING PERMIT ISSUED-_._--- ------ ---- ---- -------------------------------------------------------- DATE--------- _ _ Alterations and/or recommedations:------------------- - -- ------------•-•--------•------------------------------•---------- _. __..------•- ---- 4 ----- ------------------------- - _ _________________________ " _-_-.- - - --�------------ .- •----- ---------- ------------------------------- -•---- ---------•--- -!-------- ---- - FINAL INSPECTION BY--------------60_--Qs-------------------------------- 1 Date....2_ ------------ - - - ----------------------------------- 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 145446 ATWOOD 18-54