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FOR OFFICE USE: ---------------------------- -------- - APPLICATION FOR SANITATION PERMIT Permit No. ...1.�.... .. -------------- --------------------------------------- (Complete in Duplicate) Date Issued ..... 3.6 This Permit Expires 1 Year From Date Issued l q�^ 0 7.5 o l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with County Ordinance No. 549. ' �oy KA�' S . 1d C_t4 J c_;e`{ )4 t/ ', n ,Qy JOB ADDRESS AN LOCATION---./f..�,.._r- ./6 ...../� �-- _._ �j Owner's Name..`_` .140 V�' l_!.�l.�. .!h.� -- Phone. e d � Address.............. -- s.11... . 1 f-1. C. � lZ1 C �--------�� Z Contractor s Name__ Aqht .:__ Phone, t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 � Number of living units: _1...___ Number of bedrooms Z__ Number of the _...�_. Lot size .___.�_��•._._X..., ..a...................... Water Supply: Public system ❑ Community system ❑ Private Depth to er Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand loam Clay Loam [] Cla .❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date____________________} No New Construction: Yes [ to FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.+ank or cesspool permitted iff ubllri}c sewer is available within 200 feeet.).)� ' Septic Ta Distance from nearest we{I�_-fi✓_-P_Distance ror�2fp nd tion___'-- -------- ---Mater' 1___ -.._____._:_';__.........._...._.__,�.. ,.� . - _ r .... _ .. __ _. . . _. _ 3-Co� Lig iu d de th-.._., J+ ---- -•-- i No. of compartments----- _Siz ;r4_____________ I? Capacity... . .. (/ Disposal F' Distance from nearest wel��-_____Dis ance from foundatioft_., ....-._--•Distance to neares+�lo?+ l�in/e`.__-_._ Number of lines__e,.,t:____ Length of each line-__l�.`.1_r___0_ Width of french_____________7`•-0�----------- _n 1216 Type of filter material.._ _` Depth of filter material--_� -��_.-_.__Total length__.. �i.�_.�--------------•--•• "i Seepage Pit: Distance to nearest well__________________ _ 'stance from foundation___..._____.-.-.....Dis+ance to nearest lot line----------------- Number of its Lining material........•--------------Size: Diameter------ ---------------- Depth--.-----...-----•-••--......_.-_. El Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____........_.....____.......-------- ❑ Size: Diameter--------------------------------------Depth--------------------------------•-----------------_Liquid Capacity----------------..-...------gals. �a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ C1Distance to nearest lot line---------------------------------- •• ---------------• --------•------------------------------------------- -----•-------- Q Remodeling and/or repairing (describe)---------- ----•------------- ---------•-------....-----...--------------...----•----------------•--------•-•------- .----•-----.-----• ----------------------------------------•------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat rules and regulat' ns o th San alga uin a Health District. (Signed)----- ---• - f- i Pbu j -'------ --------•-------.----------- Contractor) By:---------------------------------------------------------.----------------------------------- - (Plot plan, showing size of lot, location of system in relation to gs, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY - - - APPLICATION ACCEPTED iiY--------------------------------------------------------- --- � 1 ---- DATE--------- `'�� ---------- REVIEWEDBY------------------------------------------------------------------------------------------------- ----- ------------------ DATE------...._......_...------------------•-----•-------------- BUILDINGPERMIT ISSUED.--------•---------- --------- --------------- DATE-------------------------------- --•---•----•-------------- Alterationsand/or recommendations:------------------------------- ---------- ----------------------------------------------------...•-----------•-_.....---------------------------------........ .................••-----------------------.................. •-------------------•------------------- ----------•----------•---- r -----"-----------------.....................................•---------------------..----------------------------- -------------_______ -- ------ - • ----•---------••-•----•---•-...__•••--•----'._..-------•------------------•--------------..--------------- - FINAL INSPECTION Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamor!Strout 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eli 9 REVISED 8•99 2M 8-61 ATLAS i