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41SY ► � ( APPLICATION� ON I=OR SANITATION PERMIT Permit No. .__-� (Complete in Duplicate) s�/V/sc +k Date Issued ___. _/ - Applica+•ion is hereby made.fo the San Joaquin Local Health District for a permit to construct aTd install thework This application is made in compliance with County Ordinance No. 544. ' k herein described. JOB ADDRESS AND ATION_______ _ Owner's Name . Address..l �a l i� -----------------------------w Phone---- Contractor's Name-,------ Y� -------------------------------- �f. ' /� ------------------- -- - - --- -------- ---------•------•--- ----------- -------------- Phone.._-",;a.:"�O�(m Installation will serve: Residence Apartment House ❑ Commercial L1Trailer Court E] Motel ❑ Other ❑ Number of living units: _+4f____ Number of bedrooms __lumber of baths Lot size _ "--- Water Supply: Public system ❑ Community system.[].- Private [I Depth.to Water-Table f#. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam El Clay ❑ Adobe 2--Hardpan E] Previous Application Made: Yes (] No New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if``prrublic sewer is available within 200 feet.) Septiic�k: Distance from nearest weIL1�4 --Distance from compartments fo unda#ion_ T-------------Mater-i-al--- • ----- '�_' -p-yA No. of com artments-____ Size- '` -k �---•------Lqp --- --------Ca acity� v\ Disposal field: Distance from nearest we1i_0g4-xA.-_._Distance from foundation_Z---------------Distance to nearest lot line___- "" „ Number of lines___._ Len th of each line___ 'e__ _ 9 +.7t{ J �� Width of trench---,;%— -`---------------•--- 7ype of filter materiaf_{__.__ .. --_ ----Depth of filter material_.__".� Total length____�,1"�?_°"" material- it: Distance to nearest weli_�ei�k1--_---Distanc fro foundation___-�D_'...Distance to nearest lot liney�_. Number of pits...- ---------------Lining material_ . ____Size; Diameter- - ". n �' " _ ___.,___.De to p --------------------- Cess71 Distance from nearest welL_ __Distance from'foundation._-.______________ Lining material ---------- -------- ❑ Size.: Diameter Depth --•----- ------- ---Liquid Capacity -----------------gals. Privy: Distance from nearest well---------------------------_------------_---:_--Distance from nearest building 9 ----------•--------------- ❑ Distance #o nearest lot line__-._..-_ :. - - ------------------------ Remodeling and/or repairing (describe):__..__._--______ --------------------------------------------- r _ Y . _ __ __________________________________ t . --------------------- ----------------------- -------- ------------------- __________________________________________________�_.----------------___-_ __-_-_.___-_._-.--____-____.___...___ _.____P_.__.._ ________. ___________"__________________.__._____._____._"__.-__________._____"__.-" I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).._ DAY& NfGHT F 3`eprti�"Tank 5ei• Te --�-- ----------- -------- ---- -------- ----------- ------------------------•------ ----( wn Contractor) ---- By:_ i106 So.E1dQrado---HC 2^7046-------- - ------ --- - Title - ---------------- ---- (Plot plan, showing size of lot, 1861{Rfir&f§fem in relay to wells, build gs, etc., can be placed on reverse side). ------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y___ ""-""-----------------__�\ ---ZZZ ------ DATE-- REVIEWED BY --------------- ----- '3------ BUILDING PERMIT ISSUED--------------_- DATE ---------------------------••----•-------- -- ---- ------ DATE. Alterations and/or recommendations:- to-_ 1 -`----------- ----••---- _ �-� ---------- _ .- -- � ----------------•------ -- -------------------- r FINAL INSPECTION BY:--- ------- Date--- ?�--`-_- ---"" ---------------------------------------- - t •------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E-9 -9-2M iasaas ATWOOD iz-sa