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FOR OFFICE USE: ------- ---- APPLICATION FOR SANITATION PERMIT Permit No. I.......------ --- - ------- ----- ------ -_ ------__------ (Complete in Duplicate) Date Issued - ----------------------------- ---------- ___________ ___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein scribed. This application is made in compliance wi }1 Cg68ty Ordinance No. 549. /�1 ' , ,7�+"g`r� 708 ADDRESS AND LOCATION e--- -_ A �� -•-•----------- -- •- -----------•-t••-- Owner's Name--------- lN_._.. _.. Phone-----•---•-------••-_-----•--•---- Address-----/ ----- -• . Contractor's Name----------- Phone.........................•--------- Installation will serve: Residence Apartment House Commerci I Trpil Court Motel Other ❑ Lot size _.. •• L� •�.�©......... p � Number of living units: ---./�__ Number of bedroomsmber o at s tem Community system ❑ Private Depth to Water Table Water Supply: Public system ❑ tY Y Character of soil to a depth of 3 feet: Sand X Gravel [ISandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3Hardpan C3Previous Application Made: (If yes,date._1_j_ --rV-.) No ❑ New Construction: YesNo E] FHA/VA: Yes ❑ No, 3' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / SO/� t -D-------.Mat ria . /.d._�..... Septic Tank: Distance from nearest well-_ Sr_____Dista a from foundati n____ _ 7' .� No. of compartments-_-1.,-- ,�+ ----Size--- Xlr--7--_,K_S_Liquid depth------- 3j-_Capacity----f a d Q__._.__Distance to nearest lot li e. Dispo a1 Field: Distance from neares well__.:7--4-----Distance from found tion...___•. -- Number of lines______ ________ __ __Length of each line' '� of french----- ------ Number � -- /� ! Total len fih------1 �Q ------••--------- Type of filter materi 1.. - __ epth of filter mater�al_______r__ _ / � Seepage Pit: Distance to nearest well_________________ Distance from foundation....................Distance to nearest Olike---_--_____--••-- i ❑ Number of pits--------•------•------Lining material-----------------------Size: Diameter-----------------------Depth-•---------------------._...----- Cesspool: Distance from nearest well_______________-Distance from foundation---.---------------.Lining material----------------------------.__..._._ �; ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity--------------•-------- .gals. Privy: Distance from nearest well-__------------------------------------- -------Distance from nearest building-------------------------------------.-.-- ❑ Distance to nearest lot line--------- ------------ -- --•----•----•--------•-•---------------•--•----.---------•------------------ -• Remodeli g an / repairing (des rlbe):.- •-------•---•-•--------------------- ---- - -------r15=-�Q -------------------------- I hereb y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, a ru nd regulations of the Sa oaquin Local Health District. (Signed) �r ;?_ -------------------------------•----------------------------------------------•--------(Owner and/or Contractor) BY: -- ------ -------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•----------------------- --••---------•-------------------- DATE------- u REVIEWED BY - --- DATE.-._... " '+ �.1 BUILDINGPERMIT ISSUED-----.-_----------------------- ---------•------------------------------------------ ... DATE_ Alterations and/or recommend tion --- -- ------ -- ----- --- --------- -----•--------• :_• '= f - F � Q ��-•--•----_ .. --.- .- - -- --------- ---- 7aa.��7f.. - c1e' �y,�,� ---- ----------------------------- --------- ---------•---•----------_ ------- --------------- -•-• 44?,; S-z7 �� •# r FINAL INSPECTION BYLPaa205 ------ --- -------- ---• 1--- Date---- -- ---- -------------------•-------.------------•------------------- AL HEALTH DISTRICT 1-6 (O� 05 th American Street 3 0 West Oak Street 144 Sycamore Street West 9th Street Stoc ton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.99 214 5-61 ATLAS _ a