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.. r Permit No. ."_-•��--...-...... ' APPLICATION -FOR SANITATION PERMIT .�7 (Complete in Duplicate) Date Issued ------ 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 N,of. 544. JOB ADDRESS AN OCATI N Q 1 l Y ---------------- -�------------------------- - - -------------- Phone-------------- --------•----------- Owner's Name.------ ---- ----•--•---- Address__"_ _�, +J--- Phone. . ------------ Contractor's Name------. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �- Apartment Hausa ❑ � f� Number of living units:/ _ Number of bedrooms _"dumber of baths ----/-- Lot size _.___ . --_--_ _. y y Private ❑ Depth to Water Table,60- ft. Water Supply: Public system AL—Community system ❑ Cla Clay Adobe Hardpan C]Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam ❑ Y Loam ❑ y ❑ Previous Application Made: Yes ❑ No [] New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 280 feet.) Septic Tank: stance from nearest well --------------Distance from foundation--------------------Material--""_"-._..--------------- •--------------------- ofcompartments :._.Size Liquid depth--------------- ----------Capacity----------------------- of ield: ' tante from nearest well------....... Distance from foundation__"-"-.-__-_.._.._Distance to nearest lot line_.__.____.______. ❑ er of lines--------------- -------------------Length of each line-----------------------.------Width of trench----------------------------------- Ty e of filter material.........................Depth of filter material-------------. -.--.-Total lengt __..""_..."_...__-----.------------------ istance from m four�dation___�"Q-•------Distance�o nearest lot line_" "_4------ Seepage Pit: Distance to nearest well__ �u - _Depth.-Q� '�------------------" _ r>!e: Diameter- __9V Number of pits.__._._" .__--------Lining material1. Q nce from foundation.----------------" Cesspool: Distance from nearest wO-----------------DistaLiquid Capacity gals. Size: iameter--------------------------------------Depth--------- -------------•---- } El ----------------------- ---- ---Distance from nearesi building------------------------------ ------ Privy: Distance from nearest well .- Q\ ;F Distance to nearest lot ine-------------------- ------ --- -------•------- --- -- = = --------------- --------------------- --------------- -------"--------------------•----------•--------•-------------••------•-------------... Remodeling and/or repairing (describe):----............. .. ""--""--""""_."_ -------------- --•-------:.•---- ication and that done . ! hereby cer+'awsthat and ulesanpdr egulafionred this s olf +he San JoaquinhLocal Heawill ltheDi tr c}n accordance with San Joaquin sun y i ordinances, State , -------- ------------- --------- -------- o caner and/or Contractor (Signed)---. ---- ------------ - ---- -- - --- - ----------- ---------(Title)--•---------------�---•------- --------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .. DATE------�2g-------------------------------------------- ------ ------------------------- APPLICATION ACCEPTED B ---- ------ ------ -- DATE-------------- ----------------------------•------------ REVIEWED BY-------------------------- ----- ------------ ----- - - -DATE----------------- -- ------- ---------------------------- BUILDING PERMIT ISSUED-------------------------- Alterations and/or recommendations:.__.._.._.._._ r. ,------------ __...-. --"-A------- ------- -- ------------- - ---- ------------------ ----- - • -- ------ Date--- -------------------- ---�-�.-`.�-�- �..�---- ---- - FINAL INSPECTION BY:-._--.--- -- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street 13o South American Street Trac California Stockton, California Lodi, California Mentees, California Y� E5-9 - 145446 ATWOOD --__