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FOR OFFICE USE.. Ej---- -- . �- �l—L= APPLICATION FOR SANITATION PERMIT- -- ERMIT . . 7 r t N' Complete in Duplicate) Date Issued -_----- -f _ :_fel - E-- ... This Permit Ex fres I Year From Date Issue hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described; P,pplication �s y , This application is made in compliance with County Ord' ante No. 54R. --- ------ JOB ADDRESS AND.L-CCATION Pho e------ -= I ••- Owner's Name.----.. � �—. — _ . . ... r� i •- Phone. Address.----..�-f ----•• - - -- -- ----• Mote ❑ Other Contractor's Name-------.._.i.. - Commercial ❑ Trailer Court ❑ Installation will serve. Residence partment House ❑ 4 .1 , ...........-__._ Number of baths ._/-- Lot size ...-•'.-- Number of living units: _�--- Number of bedrooms -- • De th to Water Table -zv ft. ` ty Private ❑ p Adobe lerdpan [) Water Supply: Public system �ommuni system ❑ Clay Loam ❑ Clay ❑ # l Gravel ❑ sandy Loam❑ Y Character of soil to a depth of 3 feet: Sand ❑ , No A/VA; Yes ❑ No 1]i t ; New Construction: Yes ❑ Previous Application Made: 'Ilf yes,date----------------- -"1 No ❑ ) TYPE OF INSTALLATION AND oSPECIFICATIONS:if c sewer is available within 200 feet.) i (No septic tank or ce'`ssp permitted �,. i Distance from nearest well---------------•-Distance from foundation__.-.------•----- -Materia__.-------C, - ti Tank Liquid de th----------------- Capacity..__......_...__._.._-- No. of#compartments. Size._..-- --- -•--• q p. 3 stance from founds n_-"-- �f ...__Distance to nearest lot line.��_--_•••••••- Distance from nearest y+e4i_ --- --• ---- / :�, Width of trench.___.- t a ; Disposal Id: �en th of each line__ ,� Number of lines-------------- -• - ----- g Total length-•------1---••---•---:��---•-�. Type of filter material._/�- epth of filter material___ -- I y- 3 Distant r f" dation___, -- Distance nearest lot Gne___� --•----- -- Size: Diameter Depth Seepag It: Distance to neare's well- �---------. t Numb zr of pits-------/•--•-------Lining material__.__ Ditance from foundation.----- Distance from nearest well----------------- sLiquid Capacity....-------------------- gals. Cesspool: ❑ Size: Diameter. ------------------------------------Depth------------------------------ ------------------ rest building 4 c Privy: Distance from nearest,well-------------------------------------------------Distance from nea - ❑ Distance to nearest lot line_____________________----------------- - 1 - F -----------------------------------------------. ____________________________________"-_...__..__._.....__..---- --------------------------------._.. Remodeling and/or repairing (destri F� "-"",-____"_--_ • ----•------ I - _________ ____________________________________________________________________________________________________________________it._._____.__.__:.__.___.______. ' -------------------- ""''""" 'cation and at the work will be done in accordance.with San Joaquin County I hereV that I have r red this app 1 ordinancesw rid rule a' regulatio s -the SN. an equip Laal Heal+h Contr ) Si ped .��r'•t�'� nbr rtd/or actor( 9 )---- --------- le)------ ----- By.__-------•--•......----•-"--=........................... --• build gs, tc., ten be placed on reverse side). (Plot plan, showing size of lot, location of sy in relation to wel i I FOR DEPARTME E ONLY z4 DATE l _ --�---••----------------------- �i I --------- DATE-== ---•------------------------ APPLICATION ACCEPTED 13Y_." -- -- ---= -- -= --==-- - REVIEWEDBY-------------------!-------------- -------- = DA E. •------ ---------- •----------- BUILDING PERMIT 155UEQ -, ' ' ro ------- c.. .[ Aherations and/or recommendations:-l-1---- ............................ WL s -----•--•------- -- I - Date------t4-'-1_:'. �_.1------------------- - - - ------------- --- -- FINAL INSPECTION --•--- ------------------------ SAN -----------------"-- --SAN JOAQUIN LOCAL HEALTH DISTRICT ymor�Street 405 West 9th Street 300 Wort Oak Street Tracy,5WCalifornia 170 South American Street 144 Sea Manteca,California Stockton,CalfFernla Lodi,California EE 51 REVISED 8-89 2M 5-451 ATLAS