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FOR OFFICE SE: - APPLICATION ---- -----------------------------------------------.. N'FOR SANITATION PERMIT -------- ------- ------------------------------------- (Complete in Duplicate) Lc. _ Date Issued -- _--------.._.. This Permit Expires 1 Year From Date Issued Application 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 compliancerwith County Ordinance No49. JOB ADDRESS AN OCAT N--•--• ®-- -------- ............................... PhonePhone Name.•` ------- ----••--------••--•-----------•--•-- %3 -----------------•-----•--••----•----•--------------- ---------------------- ----Address------..... - ----- e Contractor's Name... , ... YDS[ Phon --- Installation will' Residence Apartment House [3' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: __ . Number of bedrooms _.cZ Number of baths ___/_ Lot size ---a5-90_-- ..... _1�-Q-------_--•.••:•- .. ..� , t Water Supply: Public system [I Community system ❑ Private Depth to Water TabieQ ft. Character of soil toe depth of 3 feet: Sand [-] Gravel [I Sandy Loam ElClay Loam ❑ Clay ❑ Adobe[ ardpan C] s Previous Application Made: (If yes,date____________________) No �ew Construction: Yes E] No C]- No Yes ❑ No ❑ i k TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) 4D'isposal pts nk, Distance from nearest well_________________Distance from foundation___-.___----______-rMaterial..._______--______---------------•-...---..------ No. of compartments--------------=----------Size----------------•---------- --.Liquid dept--------------------------Capacity-- •-----------.'---- d: • Distance from nearest well- d__._Distance from foundation... '� Distance +o neares+ lot line. _..._.._. Number of lines._...-._-_- ---•- ----- Length of each :liine____�Q-.......... ...-Width of trench.---- ��--.-•-••-•-�--•.-- •' Type of filter materiel. Depth of filter material------,L',�_-______Total length.....................3©--........ Seepag it: Distance to nearest well__f®_Q_�__ .__Distant�m foundation._s, 4__�____.Distan�e to nearest lot line... ..___._ s Number of pits------/------------- Lining material. ----.Size: Diameter-----3_3.--- --- Depth.-.-----RS---------------- Cesspool: Distance from nearest well_________________Distance from foundation-----------.__.----.Lining material------------------------------------. ❑ Size: Diameter.__. ---------Depth---•-------•----- ----------- %A ------------------------- Capacity-----------_-------•--••----gals. - Privy: y Distance from nearest well _____________________--------------------------Distance from nearest building--------------------._---_----._--------- ❑ Distance to nearest lot line------- --------------- •-- ---------------------------------------•------•--•--•---- Remodeling and/or repairing (describe): ---••-------------------_-- --•---------•-•---- v -----------------I—------------- _----------------------------------------______________________________________________---------------_ ------------------------------------- -----•-- - -------------------------------------•----....:----------------•--PP-----------•-------•----------•--------•--------------•-------------------------••--- I hereby certify that I have prepared this a lication and +hat the work will be done in accordance with San Joaquin County 1 ordinanc +ate laws, a rules and r gulations o he San Joaquin Local Health District. 110.1 Si reed_ _ -- _s--- ••- -- --•- Owner end/or Contractor) t 4 ) I . By------ --•--•----••---- --• - ----------------- ------------------- (Plot plan. showing site of lot, locationf system in relation to Its, buildings, etc., can be placed on reverse side). 4. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----- '��``` : DATE 17-------I---- -_�� ----------------- ------ ----- IREVIEWED BY----------------•----------- - - ------------- DATE-----•-----------------•----------------------------------- BUILDING PERMIT ISSUED---------------- .- ------ •--------- DATE ---- -- Alter tions and or recomme dati ns .�--------- t --- -- '................. -• - i -------------------------------------------------------------------------- ........... -----•-- --------•---- ----------------------- FINAL INSPECTION BY:..__�--- 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 i ES 9 REVISSO 0.89 2M 5-95t ATLAS