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rt'RvrrlLl UJC: --------------------------------------- ---------- ---_---____ --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__,1..�..0...7 L -------------------------=------------------------------- (Complete in Duplicate) Date Issued -_....n�... . --- --- ------------------------- -_----------.--- This Permit Expires 1 Year From Date-Issued `SOS—ZSO Application is hereby made to the San Joaquin Local Health District for a permit to construct and install 48010r,',A ��,de bed. This application is made in compliance with County Ordina ce o. 54 . JOB ADDRESS A D'LdCATlO J --- --- . ......... / Q ••Owner's N`a e.. Phone �t''"`f-" •'� t.r". -- Address- - ------•- Contractor's Name............ --------- ---•-----------.-.-"- --•------ Phot Installation will serve: Residence Number of living units: ______�umber of bedrooms_____ Number of ❑ Troller Court ❑ Motel 0 Other LK Apartment House Commercla f baths ---1... Lot size A--------------------------------------- -............ Water Supply:—Public stem❑'Cbmmunity system [I Private ®r-15epth to Water Table t Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam .-Cie Loam Q Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: llf yes,dote--------------------I No ❑ New Construction!: Yes ❑ No Wry HA/VA: Yes ❑ No ❑ .i_�-TYP"F INSTALLATION-AND-i$PE-C FICATIONS: (No septic tank or..cesspool permitted if public sewer is available within-200 ZP1 Te&nk Distance from nearest well_________________Distance from foundation___________.__...._.Material................................................. No. of compartments-•---------------------_-Size--------------------------------Liquid depth--------------------------Capacity....................... 0DI"s so eld: Distance4rom nearest well___________._.-_.Distance from foundation...........!.Distance to nearest lot line,................ ta. Number of lines------ ---------------------------Length of each line--------------------•)••-"-.Width of french.............--------------__._..-- 1 Type of filter material-------------------------Depth of filter material-------------- "--._:Total length.........------_--._......--_•-__•---•-••- , i Seepage Pit: Distance to nearest well-0400- -DistancZ_� f undation.. i aryje to nearest lot Iine/ohQ.Q_1 I �— Number of pits----- ___-_.--__Lining, material_ C.� Size: .Diameter_" .--"_..-___,De th__..�_�`........... . . o� ^ p Cesspool: Distance from nearest well_________________Distance from found�on....................Lining material"""""""--_-"__-________._............ "Liquid Capacity gals. Size: Diameter--------------------------------------De th � ...------------------------- ❑ p .. tie Privy: Distance from nearlst well _________Lu_}__" --------..Distance from nearest building------------------------------------------ i! ❑ Distance to nearesti ot-line---- - .- Remodeling nd/or repairing (describe):------------------ -----------------------I-- -------------- 14- ------------------------•----------_--••-•--••--••....•••. --•---....---•------.:.... ------------------------------------l.......--- --- �---- ------------- - ---=-j ------- ---------------------------- -------------------•----•---•----------.--....._...-•------•--.._........... :- -------------------------•-----•-------•-------------------------•------------ AW I here y ertify that II hav re ared this application and that they-work will be done in accordance with San Joaquin County ordinance + t la nd a regulatlo s ofthe Joaquin'Local Health.District, d (Signed)--- .. `- ---------A------- - -- ----"--------- ----- - caner and/orContractor) plot plan. showing size of lot, location of system in relation + 1 ( i+le) - . ---•- { p g y s, 'dingst etc., can be placed a reverse side]. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY____' R. _�_____________ ------- DATE - �1-----------••------------- REVIEWEDBY---------------------------------------------------------------------•----------------------------------- ---------------... DATE------------------ BUILDING 'PERMITISSUED_-.•-----------------------------------------------__----------------------------------------- .-•-- :DATE-------------------------------- Alterations and/or recommendations-------- --------------------------------------------------•-------•••---------------•---------•-•------••----•------•- ....------------------------------------------------------------ ---------• ------------------------------------------------••-•--•-....•--------------------------------------------------------------------------- ------------------------------------------------------- --- •--- --------------- ------ -�-- ------------------------•--"--------------------_-----:--------.------------•-----------..------•----•---•--- ------------------• ------ - ----• -- ----•--------•---- - ----- --- - • •- FINAL INSPEC ! ._'. - _ Date ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street %300 west Oak Street 124 Sycamore Streets 205 West 9th Street • Stockton,California Lodi,California Manteca,Californiia�s Tracy,California ES 9 REVISED 5-99 $M 5-61 ATLAS � � - +M �