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- . ---9�1. --� ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ 75 --------------------------- (Complete in Duplicate) Date Issued ------ � :.Y ------------------ -------------------.--- 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 compliance with County Ordinance No. 549. JOB ADDRESS AICD LOCATION-----•- ----------_------ � •----••--,-..�.-`•�------------............. Owner's Name------1 =' AddressRA= = ---------•----•-------------------------------------••-•-•----•----- ...---...----•-•--•-...... Contractor's Name..___ ��____4��r--�_. ...�?"�-� r ��` Phone--_14-6 =./.X4 ' ,�-Rte:--1--••--••------::.. ....... Installation will serve: Residence D partment House ❑ Commercial ❑ Trailer Court ❑ Motel P Other ❑ Number of living units: ___L____ Number of bedrooms _`�__ Numb'er of baths __ ._._ Lot size Water Supply: Public system ] Community system ❑ Private RDepth to Water Table ....... ft. \ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [3 Adobe 2--lHardpan ❑ Previous•Application.Mad-a:-( _yes;date:,-_,, ,:._>-------) `'No New Construction: Yes �o ElFHA/VA: Yes E] No ®` TYPE OF INSTALLATION AND SPECIFICATIONS:'- (No septic tank or cesspool pemitted if public sewer is available within 200 feet.} optic Ta : Distance from nearest well_________________Distance from foundation___---__________._.Material................................................. No. of compartments-----I---•----------------Size---.----_-----.------------,...Liquid de h------f-------------------Capacity Disposal Fields Distanc�:tror4i nearest weIL--S _____Distance from foundation....,.L2Distance to nearest lot line_ •_.._.._ Number of;�lines________ ___ ___________________Length of each line___.-__S --__________.Width of french......_.._4=�/_....__.._..___ r Type of filter material---g_ac1�C------Depth of filter material-------/9-_f`______Total length_______ (.?�______________ _____ (j eepage Pit: - Distance to nearest well____ -li':'Q-------Distance from foundation.....i&........Distance to nearest lot line__s....... j rr r Number of pits____-_1.... _� _Lining material....0�' .._Size: Diameter-__ € :._......__.Dept h__->I-_-____ar�'aG... Cesspool: Distance from.nearest w!___r______________Distance from foundation_______-_____---___.Lining material_______-_______________.............. ❑ Size: Diameter� ` - !i 4 �------..De th------------------------------------------- Liquid Capacity p 9 ----•--•--••----•----._.._._gals. Privy: Distance from nearest well- t----------------------------------- ----s_D.istance,from nearest building------------------------.----------------. Q ❑ Distance to nearest lot line-----------•-•,--1___________________-____•_---------------_-_--• [ .-•-----------•-----•-----•------•---•---••--------------------------- t Remodeling and/or repairing (describe):----_-- ---------------------� �`-,L�----�2��--•---�o-----�ia(.C..o.��-n.�--.... ��L�s?-,,,^,t�.... ----•--- -----••-•----------------------------------------- ------------------------------------i I hereby certify that I have prepared this applicatioinand°that•the—anddyne in'l�eiordance with San JoaquieCounty ordinances, State laws, and rules and,regulations of the San Joaquin Local Health_ District. {Si ned == = A-a.-.-�� c_�. 9 )•-•- j.=`•��-.�` �--�- - --------- ------------------------------- ` i--------...------=----------(Owner end/or Contractor) (Plot plan, showing s��ze of lbs, location of system in relation to wells, buildings, etc., can be placed on reverse sidal.It /'L � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED------------ Y----- c'�- ------------------------ DATE `4 REVIEWEDBY------------ --- .... --------------------------------------------------•---•-------------------- DATE BUILDINGPERMIT ISSUED------------1------------------------------------------------------- •-•----•--------------------.._ DATE.------•--------- -----._...--------------------------------- Alterations and/or recommnd'ations*_.__..... _ 11c ._.�#. = y,- ------------k------••---• 7 -- .................. -• -------- ------------------ --------- ---------------------------- -----------------------------=--•---------------------------------------•------- ------ -----------------------------------------------•--------....---------------------•--------1 -------------------------------------------------- --..._ ------------•------------------------ ------------ FINAL INSPECTION BY:.---- r Date----i4------9j' - °�— ' „ �. 0 SAN,J6QUIN 4LOCA114ALTH'DIVIRi T '4 } 130 South American Street 300 West Oak Street 124Sycamore Street 205 West 91h Street Stocktan,California Locil,California Manteca,California Tracy,California ES 9 REVISED 5-99 YM 5-61 ATLAS