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FOR OFFICE USE: o - ii ' Permit No. . -�------ ------ I APPLICATION FOR SANITATION PERMIT ------------ (Complete in Duplicate)------ � p ) Date Issued ...------•�--(�-----�3 � " } This Permit Expire 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perm) to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1. ,, eom, e tte % __& JOB ADDRESS AN LOCATION_ . -_-- - gc�. er •••e� �6 +� `- ... -----• a - Owner's Name___ --•----- •------•----•---•- ----------------------------------- Address...-------- -----• --......o 'r.'x.:�... Contractor's Name------.._ :_. Other Commercial ❑ Trailer Court ❑ Motel ❑ «.� Installation will serve: Residence ❑ Apartment House ❑ �O 10 Number of living units:/- Number of bedrooms Number of baths _ v- La} size .-_____. Private Depth TO Water Table _------_ f{• Water Supply: Public system ❑ Community system 11Private ❑ Hardpan ❑ Character'of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ No ❑ Application Made: (If es,date---------------- ---1 No � - New Construction: Yes-41 No ❑ FHA/VA: Yes ❑ Previous App' y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)x Septic Tank: Distance from nearest well_________________Distance from foundation_.__.___..------•--Materia-___--------__= -ci --------------------- - - -------------- No. of compartments - Size ----------------------------Liquid depth Capacity Disposal Field: Distance from nearest well-----------------Distance from f'u�neda#ion----------- ---W Distance ofttrenchest lot line----------------- p ❑ Number of lines----------------------------------Length of each ---Total length..__.- --•.---- ------- Type of filter material_________________________Depth of filter material----------------------- I t Istance to nearest line_..af-.-------- ��Distance.irom oundation____.�.1 .-- � � S Distance to nearest ---------- well Depth-__ __-.__ d Number of pits- __.-1 ------------Lining material- ---------------- ----Size. I Distance from nearest well--____.._,;___..°Distance from foundation--------------------Lining materia.. a�$ -cesspool: I Depth -------------Liquid Capacity----------------- •--•---9 ❑ Size: Diameter..-------------------- I Distance from nearest building-------------- -------•------•----------- Privy: Distance from nearest well---------------------`--------•---- = ❑ Distance to nearest lot line------------------------ - ,- ---------------------------- Remodeling and/or repairing (describe):--_- -- ` i -------•-==----------•---------------------•------•---------------------•----•-----•--------•------••------- f ._---••------•-------------- .. ----------••-----•----•---- ------------•---------- y...---------- ------------------------ ----•-----------•---•--- — --•---•--------•-- --------- --- i _______________ --------------- ---- -----_________________________________________________________________________________________________________________________ I hereby certify that I have preparedulat ns elf the San .l that i h worcalkHeall be don c in accordance with Sand Joaquin County ordinances, State I s, and rules and reg (0viwr—anxVor Contractor) -- ------- - (St ned = __. 9 } _ -------- -----(T'itle)---------- ----- ------------- By: _ - .----- --• (plot plan, showing site of lot, Iocetion of system in re ation to W610, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY w = DATE_.._'r?'-C------- APPLICATION ACCEPTED BY__- . - --•--------------- ------------------------------ ---------------------------------------- DATE REVIEWED BY_..---•------•-----------------------�------- - -------------------------------------- BUILDINGPERMIT ISSUED_..-------------- ----------------------------- ----------------------•------ -------------------•----._------------------------------------- -------- Alterations and/or recommendations:_____________________ _ _---- ----------- ________.. .- ----- ------------------ iDa+e_Date_,"? '-- =1 ------- .......... ------------ ------------- FINAL INSPECTION BY:... SAN JOAQUIN LOCAL HEALTH DISTRICT �300Wst Oak Street 124 sycamore street 205 West 9th Street 130 South American Lodi,California Street Manteca,California Tracy,California Stockton,california ES 9 REVISED 8.59 2M 5•62 ATLAS