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FLC Per No..:._.. . ,.. ' { .f APPLICATION FOR SANITATION PERMIT_ -�)?� --ys `:r � ' Da+a issued .1/4 (Complete in Duplicatey -- - - This Permit Ex ires 1 Year From Date Issued P lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. lis application is made in compliance with County Ordinan F ....................................... JOB ADDRESS A 6 ATIO ....- ---- -- - -------- ��.- Phone...... Owner's Name..__ ._ - - -- -••-•- Address___. _. Contractor's Name------------ --- -------•--•------ ---• - Other El ii Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ins+ally+ion will serve: Residence / �" •Z ................ Number of living units: . _.___. Number of bedrooms • Number of baths .,/..- Lot'size ��ft. Private ❑ Depth to Water Table _. Water Supply: Public 'system Community system ❑ Clay Loam ❑ Clay ❑ Adobe[�ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ,_,� No [IPrevious Application Made: (If yes,date--------------------) No C] New Construction: Yes ❑ No L� r�A/VA:Yes [j TYPE OF INSTALLATION AND SPECIFICATIONS: L No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material................................................. n Distance from nearest well_________________Distance from foundation--------.----------- capacity 3 No. of compartments Size --Liquid depth_.. ....- Distance from foundation..- -- -- -•--.Dis#ante to nearesfi lot line_;�isposal Fi d: Distance from nearest we7M-C&--- '""-Width of trench.___.___. "y_---•••--- Number oflines------- ------- Length of each line__.:___._____ ` -Total length..------• � ------ ----- `. Type of filter material. ��9G/ -Depth of filter material_._ "-- '�J -"-.__Olsten e m fo ndation_ t ---•••-.Distanc�e,to nearest lot line.�.S:?------•- 4 Seepage Pit: Distance to nearest well_ - ,--------_---Depth__."pZ ............ C �. Number of Its__..__ Lining material.__ _ _�1.� Size: Diameter_ " ,!p Cesspool: Distance fi=om nearest well______________"_-Distance from foundation-----------.___-___.Lining material__.___...__..__..__..__--__---g als. Qe Depth -----Liquid CapaciiY-------• ------ g ElSize: Diameter-------------------------------- P tfrom nearest building-------------------------------- Privy: � Distance from nearest well-------------------- ...... Distance Disance I Distance to nearest of ine.--_____.-•--------------------- • " f-� Remodeling and/or repairing (describe)---------------•------- --..-.-------------------•---------•----- I --------•----------•------•--•-------•------------------- -----------------•--- --- I -------------•-----------------------------------_------------------------------ -•--•-- hereby ---•,f that I ha--•------•--------------••--------------------------------•-------------�--------•---------•-------••-------•--•------...------------------------------•------------- � have prepared this application and +hat the work will be done in accordance with San Joaquin County t' oidinan e;, y at laws, and,ru s and regul ns of the San Joaquin Loc eal District. 1 4r Contract "-• nd/o ori (Signed)- ------ It BY: b ' ings, etc., can be laced on reverse side). (Plot plan, showing size of lot, location of system in re ation to wells, / FOR DEPARTM N SE ONLY f.,:.. ..APPLICATION ACCEPTED BY--- ---------- �"�----"-"---.""" DATE........ 3 6. .---••---------- DATE--•---•----"------------------------------------------•--- REVIEWEDBY-----------_----------------�----------------------------------------- -------------------- Df4TE. " BUILDING PERMIT ISSUED — _ _....__.-- _. L�.,---- ---I--�"""----- } Alterations and/or recammenda+ions:___ _.__/_.. _ _________________________ ________________" ------•----------•---- _ _____________________ ._.__ ___-____--______________ C� Date_.---------•-- •-----�--.----- - •--= - - FINAL INSPECTION B -_•-- - � SAN JOAQUIN LOCAL HEALTH DISTRICT 1.E= . 124 Sycamore Street 205 West 9th Street 130 South American Street 300 Weil Oak Street Stockton,California Lodi,California Manteca,California Tracy,California I E$ REVISED 0•$9 2M 6-61 ATLAS