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---------------------------- ----- ----_--- .1 ICATION FOR SANITATION PERI' Permit No. ...................... --------------------------------------------------------- (Complete in Duplicate) __ This Permit Expires 1 Year From Date Issued Date Issued ..._1.................. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thwwork herein described. This application' is made in compliance with County Ordinance No. 49. V4� JOB ADDRESS AN OCAT N.____cl-__ _ _.__.. � e. Owners Name- ------------------------_..... Phone.---....-•--•--:.....- ---_..... Address........ 5)9 -------- •----------- - --•----- ----.. 7 Contractor's Name.. ! ---------------------------- .............. PhoneJY� Installation will.serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r / 'r i Number of living units: __/. Number of bedrooms _cZ Number of baths ../_ Lot size ...1.5-Q_--_-K Z.-.'`,er.._Q...•...... Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table4� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ffl- Rardpan ❑ Previous Applicatiold Made: (if yes,dote--------------------) No Rew Construction: Yes ❑ No �FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATI6N AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptP nk Distance from nearest well_________________Distance from foundation-_---__-____._.-_-Material________-_,__----.--------------------------.._-.- No. of compartments............ ------------Size----------------------------------Liquid dei--------------------------Capacity....................... Disposal„ d: } - Distance from nearest wil d___..Distance from foundation...r7 _-+__..___.Distance to nearest lot Number of lines.......,..__ ______ Length of each line____�GL'_..__._..___.Width of trench____ ._ l Type of filter material. C ..Depth of filter material____--AX.......Total length_.•...................3.a...`......_. � Seepage Distance to nearest _ atonf Distancei4.........Distance to nearest lot li ....... 3 . Number of pits..../___________Lining material_/ . � ._______-Depth_._.._._ XS............... Cesspool: Distance from nearest well-----.-----------Distance from foundation....................Lining material..................................... '' ❑ Size: Diameter----------------------------•---------Depth----------------------------------------------------Liquid Capacity----------•----------•------gals. Privy: Distance from nearest well_______________________________________.____:---Distance from nearest building---....................................... ❑ Disfancil nearest lot-line------------------------------------------------------------..........................._.........:_............................... . Remodelingand/o?; repairing (describe)---------------_-....... ---------------------------------------------------------------•--•------------------------•---------.................... -----------------------------------------------------------.........------------------------------------------------ ...............................-----------••-----------------------•----•--••----•------------------ I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc tate ltiws,'a• rules al r gulations o he San Joaquin Local Health District. 5r'ned ._------ By: _____•-_--... _ -•- -Owner and/or Contractor 9 ). . ` By=--•--------•------------------------------------•�-� ��(� - -------------•-----......(Title)-- -• -- ....... -------_----- ------------------------- (Plot plan, showing size.of lot, location ff sys8 tern in relation to Oils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY - DATE .-. ...'..-�z REVIEWEDBY--------------------------------------------- -----------------------------•-----....------••-------.--------------------- DATE-----------------•---------------------------------------- BUILDINGPERMIT ISSUED----•----------------- --------•---------------•--------- ------- DATE------------------------------------- ---------------------- Alfer tions and or recomme d'ati ns-------------------------- ----- ----- r � • -. .............._..... U - i r .--••--..•.....-•---...-----•--••.........................••---._..._.._......-•-•--............................. ----------:...................................................................................... --------------------••--•---------------- ---------•------------------- --------------------------------------------------------------...................................................................................... FINAL INSPECTIONBY:. Date ... .-..` �-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 Rill 8•$9 $M 8-61 ATLAS