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------------------------ ------ --------- APPLICATION FOP, SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicatel - ---------- --------- ------ -- ------------------- This Permit E Date Issued ... Ex I Year From Date Issued ... ...... I Application is hereby made to fhe!San Joaquin Local Health District for a to constry f and install the work herein described, This application is made in iptoairice wit ou�nOrdinance No. 549. per I I- 07) onstru tand "e work JOB ADDRESS ANDLOCATION.- A . ... ..... -t4 ..... . .. -------------- Owner's Name...'* —Z70 I.A/ --------Ar ------------ ---------------- P --------------- --------------- P Addre Ss............ Contractor's -Name - -- ---------------------------------------------------------------- ------ . A....--•-•----- •----------------•-- Phone Installation will serve: Residence El-'Apartment House E] Commercial E] Motel 0 Other, Number of living units: _077-Number-of bedrooms ----'7Nurnber of baths Lot size Water Supply: Public system E]* " ............. ... Community system [] Prjvate V-Depth to Water Table,/01 Character of soil to a depth of 3 ffiet. Sand E] Gravel Ej Sandy Loam [] Clay Loam E3 Clay 0 Adobe,'E!f-Previous Application Made: (If yesdate------_...._-..___} Hardpan ,!'i s No ❑ �Ote------------ -- No 0 New Construction: Yes [] N FHA/VA: Ye E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pIrmiffed if sewer is available within 200 feet.) Sceptic Tank: Distance from nearest welO...>l'. ----Distance ndatiOn --------------------Materia.of compartr4enfs---- ..... ................. -----------------SizeST. . .........Liquid dep�h__11_AV__'0( Distance from n ,r r rn ou Dispose is� 4 -----------Capacity/ PoSa Field. nearest we�l-"- _(-----Distanc r rn ouindation.1.6 "....Distance to nearest lot line..._ . ......... :Type of filter me Len Length of each line-, NPPF Number '2 4 - -of lines---- ...... V-I.. .... -.Width of french_ it Depth of filter material___....Illf-n.....Total length---------- --------------- we Distant 94rom foundation-- ..4 strice to nearest I.ot line..._.: '457 Number of pits. Seepage Pit: Distance to nearest9til We ------------.-Lining ---Size: Diameter-- ------- ......Depth__� 1_� eqL- ---------- Cessti pool, Distance from nearest well.................,Distance- Al 91 11.,- - , I F-1 Size: Diameter. from founclailo'n--------------------Lining material_.....'------- ---------------- ------------.Dept h----------------------------------------------------Liquid Capacity----t.. Privy: Distance from n;a.- rest well - -------------------- C1 Distance to nearest lot liri� ---------------------------------Distance from nearest building----------------------------------------- - ----------------------------------------------------------_------------------- --------------------------------------------------- Remodeling and/or repairing (describe)- ---------------------- .............. --------------------- --------------------- --------------------------------- ------ ....................................... -- - -------- lien W-----------Z --•-•---•------•"-----•-•--•--•-----•-----•---•------------- ---------------------- -------------------------- ------------------- ----------------- ------------------- -------------- , --I-_�__ ------- --- -- ---------------------------- -------------------------------- ---------------- ---- ------ e e f earecluj i, ---------------------------------- -- I h r b rti hat have epared this lication and that the work will be done in accordance with San Joaquin County ordinance ate S. and rule nd r ulati f f San Joaquin Local Health District. p - �i (Signed)--- ----- --- - --- --- -- ------ ---- -- --------------------------------------------- Contractor) By:--------•---- ------••-----------------•-•• ---------*------------- -------------- - - --- ------------*--(Title)------------------- ......... ................. . .............. (Plot plan, showing size Of lot, location of system in relatio o wells, buildi s etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B.. .Y...--..-- - --------- ----------------------------------------------- ------- - -- DATE-- - --REVIEWED BY-------- - ------------ ....... - -----------------------------------------------*----------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------*----------------••---•---------------------------------------• DATE Alterations and/or recommencrafions ------- .......... ............... ---------------------------------------------------------------I------I—_---_�� ----------- 4--- --------------------- ------ -----------------------------f9----------I--- - ------- ---------- --------------------i;�Z------------ -------------------------- ,� :: .(n&------/44%5,<. `..' ' :__ -- _: ------------ ------—------- .......... -------- -. — 1:-__W., -- --- ---- -------- ............................ ------ ----- ------------------------ ------ FINAL INSPECTION BY:....-_- ___.. --------_------------------ Date---- ------------ ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 205 West 9th street Tracy,California tS 9 REVISED 9-B9 2M a-61 ATLAS