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7>-1 b a -Z 4 C) APPLICATION FOR SANITATION PERMIT Permit No. .-71_f '....... '� (Complete in Duplicate) f / Date Issued __I3 ---`-� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to,construct'.apd install the work herein described. This application is made in compliance with Count Ordinan No. 549. }" v� � r•` Pp p �., y �C� JOB¢ADDRESS AND CAT.ONA,W_ _ BU_/,.� _-- - -�STIY�.�_4�__---�, !G}/!/�x� ��[C��GZ Q ! ---=- . Owner's Name ' ..4 �1-7A -•----• ------------------ --------------------------------- Address----------------------401 -------------------------------Address----------------------401 --------- ---- --- ---S' N� - ---- ------- �f-• •--------_._-_------------------•-- ------------------ Contractor's Name---------------------•---- - -•-------•------------ - -------- PhonW�`---- A -------------------------------------------- "Installation will serve: Residence % Apartment House ❑ Commercial F]. Trailer Court ❑ "tel ❑ Other ❑ " Number of living units: ----- Number of bedrooms,__._ Number of baths . ----- Lot size _ S x_._ .i _`C_ '. +_ - ----------- Water Supply: Public system A 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 Hardpan ❑ Previous Application Made;. Yes ❑ No K NewaConstruction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-pe'mined.if pu is Sewer is available within 200 feet.) f 144 Irl I Septic Tank: Distance from nearest well__:4W----Distance from foundation-_{0---------Material ___ ---- ------------a�__--_.__ No, of compartments_..�_._....----._:;-Size$0O:_ t L F_._..Liquid depth_ .fz_ ___________Capacity__. -.___ ___.___ " 1:. I 1_ Disposal Field: Distance from nearest we] ' Distance from foundat'on---/__..__L_._..Distance to nearest lot li ___.___.. Number of lines__°___,> _fir_- __--__-_-_Length of each line----- ---------- Type �._.___ Width of trench—A-0-44-111__________________ Type of filter materiaL/ __ _�%�_-Depth of filter material' ___f_3- .__-____Total length------- ----------------------- Seepage ______-_.-_________- Sea a e Pit: Distance to nearest well_!�' ..!Distance from foundation____ p g '�______.Disptar�he to nearest lot ----- 06 � g '4 Depth./2-f. Dumber of,pits______________________Linin mater�aL�lPf C+�_--.Size: Diameter___. ______...__. ___-.__._.___.__ Cesspool: Distance fs-om nearest well-----------------Distance from foundation__________________ Lining material__._._-..._---._-.-.____.-----_-__-_. y• Size: Diameter------------=-------- ------ - ----- Depth-------------------------------------------------_ Liquid Capacity-------•------------------- _gals. Priv Distance i Irom nearest well------=------------------------------------------Distance from nearest building--.--------------------------------------. ❑ Distance to nearest lot line_ 1 _ r i ., ---------------- Remodeling and/or repairing (describe):--- - ---- ---- -- ---------------- ---•-- ------- -- ---- -• =---•----- ------------------------------------3--------•---------------•-- - -- ----------- ----------- - /7 ----------------------------------------------------------- --------------------------- ---- --------------. -----•---------- •------•-----------•---------------------------- -- ----- -------------------------------=-----------------•------- -----------------------------------------------------------•--------•-------------------------•----•----------------- -------- I hereby certify that I have epare his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r s and re ations of t an Joaquin Local Health District. r f-------------------------- whet and/or Contractor),/- IT ontractor " (Signed) ---- ---- - -- -- ---=-------- --------- -- By:------- -~�- LCL ------(Title)------------- --- r-------------- (Plot plan; showing size of lot, location of system in relation to welts, buildings, etc., can'be placed o everse side]. f a. FOR DEPARTMENT USE ONLY JO APPLICATION ACCEPTED BY DATE_ ------------------------ ___ --_----_--------- ----------------- REVIEWED BY--------------------------------- ---- DATE_-c' '- -------------------------- ----------------------- BUILDING PERMIT ISSUED----------------------- ---- --------------------------------------- ` DATE, — --------- --------------------------••-----•---- Alterations and/or recommendations:.-- --- °>.. '='= ~- = ==`Y==- - % l --- ---------�--r------ � �A � E - - ' -- -' J- ft_. . .. - z•--i'�'' ` ` `... ..� . . 1 ,r� -. - --�- ---- •--------------------------..........--------------------•--__-___ -------------------=--------------------= -----------•- ' �'"--- ------ --- ,„ ----- -- ---_ -- --- --------------•------ 1 jfJf/gyp {��] 1 - r FINAL INSPECTION BY:. -- _. --- --- Da�'te ;.,-.- �. -- ...�Z-- , 4 t SAN JOAQUIN LOCAL' HEALTH,DISTRICT 130 South American Street 300 West Oak Street 'rte 32 Sycamore Street 9114 North "C" Street y Stockton, California Lodi, California 4k Manteca, California Tracy, California • E5 9-2M 1a5446 ATWOOD I2-sa 3 �.Pr• - - _ .#