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' FOR O FIC USE: III •. y� I ---------------- - —P - 7� APPLICATION FnR SANITATION PERMIT Permit No. ... ... - ----••--------!M_ (Complete in Duplicate) Date issued ....1... ��-- - --------------------------- -- - ................0.. This Permit Expires I 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 co"m" pliance with County Ordinance No. 549. h JOB ADDRESS AND LO ATION.... .. 77 Owner's Name..._ _____-.- �Ol-lt--- Phone_ •---- Address... •• --•----- • • •-------•--------------------------------------......................................................... Contractor's Name---- IN - t �"LJ 1 Phone -�--- I Installation will serve: Residence ��-Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitsill._l.. Number of bedroom__. Number of baths �_.-.- Lot size . �. -- Z-- - ----•-- Water Supply: Public systet, ❑ Community system Private [IDepth to Water Table -r-. ft. Y.,r Character of soil to a depth lof 3 feet- Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: If yes,date-----------------___ll No ❑ New Construction: Yes ❑ No% FHA/VA: Yes ❑ No ❑ p� � TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 fe ! �r If � Distance from foundation. Material..... Septi ,'Tank: DistanceI�rom nearest well_ --- � i� r� -F-.. . i. Ila � ` No. of compartments-.Z' Size,5 depth- __-._ Capacity __....... ----•, D,i�sP�sal �ietd ` Distance ram nearest well------------------Distance fro rtoundation-___.....____ -----Distance-to nearest lot line..................f Number sof lines----------------------------- ---Length of each line---------------- -Width of ttench CCC... Type of filter material._._:_----- °-_Dopth of filter material-----------------------Total length`__..___......._......._____..--:------_- i , { le Seepage Pit: Distance to nearest well__ ____ __----_"---Distance:from foundatio Distance to nearest lot line... .• ` .. Number of pits----,------------Lining maferial_ _41f. i er�Diameter.__ DepthJ ------------- I Cesspool: Distance)Ileter rom nearest well-------.__....Distance from foundation__-.i__-_....___.Lining material----------------------------_______. ❑ Size: Dia ------ ---------------------- --------Depth --------- --• --- --------------Liquid Capacity-----.....---- - . gals. I � • Privy: Distance from nearest well----- ----------------------=-------•------------Distance from, nearest building--------------------------------I--------- ❑ Distance)to nearest lot line________________________________ -------- F R modeling and/or repairing (describe)---------- - --• - -•----- ---------------- ......--------------------•---•-------•--•--------•---- - - ----------------- -•---••-------------------------------------------- �h -----•-------- --------- --- -------------------•-----------.---------------------------------------------------------------------------------------------- --- 6�_ _--4 I hereby certi y that I F� prepared PP gave re orad this application and that the work will be done in accordance with San Joaquin County ordinances, S+ I and rules and egulations of th�eS`a'n Joaquin Local Health District. .--- - - --."= r :..1• ----------•-------------------....-------- Contractor) (Signe' ) -••••------•-------- III r - (rtte)-----------------------------------------.. - ------------------- By: t (Plot plan, showing size of I11, location of system in relatio t wells, buildings tc., can be placed on reverse side). ' ilu FOR DEPARTMENT USE ONLY -w DATE------ _----- LT G ------------ APPLICATION ACCEPTEQi IBY---- - --- --------- -- ' REVIEWED BY--------- ------------- . - -- ----=-------------------•-------------1-------- DATE--------------------------•----•-••--••-------------------- BUILDING PERMIT ISSUEDiI_..--•------------- .----------------_.... DA•TE.-------•------------------------ ----..... - Alt r ti ns and/or recomma3ndations:.. --_ _la-r &_ .J =_ �f `• . - - .__,coo---�--r �' -------------------------------------------------- FINAL INSPECTION B : ...�1_ Date....... `Z -- ------ r{" I 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 f f ES 9 REVISED R•99 8M 5-61 ATLAS