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-� WPLICATION FOR SANITATION PERMIT Permit No. .. { (Complete in Duplicate) t. Date Issued _____ __� -- -- Applica+ion is hereby de to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compli f ce with County Ordinance No. 544. qy ...--------•------------------------------------------- JOB .ADDRESS AND L CATIONS-______..-QI_----- ----- �'t Phone 7----------------- -- Address-_-------------------- - - --------- Contractors Name L - ---- -----------_ on f ---------------- - Ph e �r-- f Installation will serve: Residence Apartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other ❑ ` /a a'------------------- Number of living units: __�___ Number of bedrooms --- Number of baths __!____ Lot size ________________ -- - i Water Supply: Public system [Community system ❑ 'Private ❑ Depth to Water Table .--_- ft. Character of sail to a depth of 3 feet:' Sand 1] Gravel ❑'"sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe �ardpan ❑ i I 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.) ptiTank: Distance from nearest'well_.____.~__.____-_D�stance from4oundation__________�_____--Material--..-_________________________________._____.- No. of compartments Size ------------Liquid depth--------- ----------------Capacity----------- ------ s Dis 541 'field.: Distance from nearest well------_----------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-----.-.-------------------------------�- .. Seepage .' ..Distance 'to nearest weii�o.� -DistanceoT foundation____- Distance to nearest lot line______ __. Number of pits------/-------------Lining material_. _..Size: Diameter---------- ----------.Depth-----o7_,5_1_-.------------- Cesspool: Distance1from nearest welL________________Di"stance from foundation___.---- ----------Lining material-----------------------------------._. ❑ ------Depth--------------------••---------------------=-- ---:_Liquid Capacity------- ---------------ga Size: Diameter____________ ______________ __ Is U _ Privy: Distance from nearest well_______________ ._----------------------------Distance from nearest building._____.._____--___________-_------------. ---------------------- ❑ Distance to nearest lot lir'e--------------------- ---•---! ----------------- ----------------------- i -------------------- t. Remodeling and/or repairing.'(describe)=--------------- - - --------•--------------------•-------------------------------= ••----- --------------------------- . I. ------------------------•--------- - --- •---- --------------- -••--------------- • - --------- •----------------------------- -------- ----- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. e - __ j�L� -------- ---------------------- I �ner,and/or Contractor) 1 (Signed?--._ --�---=----- ------- --'-�--/----/---------- - --- ----�------- ------- _ ,t_�1-......l.�f�l ----------------------•------------(Title)_ - s? . (Plot plan, showing size of lot,.location of system in relation to wells, buildings, etc., can be placed on reverse side). C FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - ------ DATE------- -----•--------- ----------------=---------- REVIEWEDBY--------------------------------------- ------ --------------------------------------------------------------- DATE •--------------------------------------- BUILDING PERMIT ISSUED--- --- - DATE__ ------ - Alterations and/or recommendations:------------ =--- - ----_------------------------------------- -------------------- ------ -----••---•-------•------- ------ ---- ---------f----------- ---------------------------- ..._.----------------..._...------••-----••---------- --- ---•-----•------------------ ------- ----••-- - - _ --------- - - - ------ -------- ----------•-------- •----------•------- f _._ -- ------------- FINAL INSPECTION BY: w Date---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l3o South American Street 300 West Oak Sheet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5 J-2M 145446 ATWOOD 12-54 1