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FCR OFFICE USE: --------•------- ••------------------------ - - *� A_ y Permit No. ��•.�.•=��x_ ,_ „ .APPLICATION 'FOR SANITATION PERMITy _ - ------------------------------------------------ f. (Complete in Duplicate) �;Z --------=----------------- -- This RiaFmit Expires 1 Year From Date Issued Date Issued --__.------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de ribed. This application is made in compliance,.ait`k County Ordinance No.,549. J08 ADDRESS AND LOCA ION - - -------------------------- --..._�-�-�� . .� Owner's Name------------- •- -=•--=- - -�-�•� ------------•-•-----•-••--------•------------ -------------------•------`- ---------------- Phone.-..•----------------•----_------- Address--I.11-3•-•:... ------------------------------------ ----------------------••-•----------- ........------- Contractors Name-.. l l '- _------- -•----•-------------------••- -'':-R c-. =t-' 'rt-------------•-•-------- Phone•-•---...•---------- i Installation will serve: Residence VApartment House ❑ Commercial 'r] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ { ..... Number of bedrooms .. umber,af baths _ .-_ Lot size . ........ -----•-- Water Supply: Public system"❑ Commuriity s em ❑ Private 71/115epth to Water Table . Character of soil to a depth of 3 feety Sand Gravel ❑ So dy Loam ❑ ' Clay Loam ❑ Clay ❑ , Adobe❑ Hardpeti❑ _,..,....Previous_AP. licationM . ade: (If. es,date__----__- ----- -_-I ,No New Construction: Yes gKNo E] FHA/VA: Yes.❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:rwr - (No septic tank or cesspool Permitted if public sewer is available within 200 feet Septic Tank: Distance from nearest well___ ��_.__Distant f o foundation-----1.:..--------Material--- �R�. p r - Size__? 9_�-_�Li uid de th_-___ ..-Ca aci IC-�`�, No. of compartments ----•- -• - --- •-- q R ---------•--• P capacity ---•------^•- Disposal field: Distance from nearest weil___� a.-_Distgance from fouQ'ndation--.._--[--.-.'Distance to nearest'lot line..........:...... Number of lines___C _--.�____---_-_Length of ea l e__ Width of french._ ___2 ................--------- Number of filter materialJ90_C_K____Depth of filter material_____jg!"-------Total. length-----/0_,0__________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- '- Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------........ ool p '`Distance from nearest well_________________Distance from foundation___._-_--_______-_.Lining material------------------------------------ Cess ❑ Size:Diameter--------------------------------------Dept h---------------------------------------------- ----Liquid Capacity gals. Privy: Distance-from nearest well---_'!'---------------------------------------I..Distan e fri -__ rornearest building--_-----------_-- ❑ Distance to nearest lot line------------------------------- --- - Remodeling and/or repairing (describe '� ---------•---••---••••-----------•--------•--•---- '------------------ ---^-•---•---•--y`-'--'•-•--- t ---------------------- /" -------------------- ---------------------------------------7_----------------------------------------------------___----------------------:------------------------.------ -----_____-__________-_____-_-_____-_-_--___-_____________-_-_--a----- I hereby certify that I have prepared this application and that the work will,be done in accordance with Sen Joaquin County ordinances, State laws land rules and gulations of the San;Joaquin Local Health District; (� (Signed) # ------U --------------------------------- -----------------------------------(Owner and/or Contractor) , ......... -------------- `-- Title----•-------------- 777_ [Plot plan, showing sizeof lot, location of system in relation,to„wells, buildings, etc., can be placed on reverse side. ° FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_--__�� 0_____-_---- -` �- ' _ ��--�---"DATE_....-�-`---...__�.--- ----�----------=----- REVIEWED BY-------- ---- ----------DATE---•---------------•---- BUILDING PERMIT ISSUED-------------------------------------------------------- - •---------------------------- DATE.......................----------------------•-------------Alterations-and/or recommendations:-------- ---�=-='=--------- - - ...-•-.......... �I --------- 6 ...................� �Di�:h �T � _.__ _- ____-------. -- ------- _ ... ----------------------------------------------- ---------------- ' ` _LSAc }------ ._-...cono P sT ----------------------------------------------------- ----------------------------------_--:_-------- r. FINAL iNSP TION BY:.-- --4,_ Date------ 1Q 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 - ES 9 REVISED a-159 ZM 6-61 ATLAS !} „ A.